Acute Necrotizing Encephalopathy Secondary to Mycoplasma pneumoniae Infection in a 4-Year-Old Boy

Abstract

Acute necrotizing encephalopathy (ANE) of childhood is characterized by encephalopathy presenting with symmetrical multiple necrotic brain lesions along with multiple organ involvement. Affected children often present dramatic and profound neurologic deficits after prodromal viral infection symptoms. We report a case of a 4-year-old boy with acute necrotizing encephalitis related to Mycoplasma pneumoniae who managed to recover from severe neurocognitive impairment. A previously healthy 4-yearold boy had traveled around America and Spain for 1 month. Ten days after return, he had fever due to acute pharyngotonsillitis. On the third day of fever, he experienced abdominal pain, vomiting, and a generalized tonic seizure. He was transferred to the emergency room with an ongoing seizure of 30 minutes which ceased after injection of lorazepam. The patient was drowsy but cranial nerve exam, pupillary light reflex, and extraocular movements were normal. Overall motor and sensory function was intact. Within 2 hours of admission the patient had three vomiting episodes. The initial diffusion-weighted brain magnetic resonance imaging (MRI) showed no diffusion-restriction lesions and the intrathecal pressure was normal. Blood and cerebrospinal fluid (CSF) tests, renal parameters, electrolyte