Clinically mild encephalitis/encephalopathy with reversible splenial lesion (MERS) associated with <i>Mycoplasma pneumoniae</i> pneumonia: An adult case and review of the literature

Sadohara, Michito; Arai, Tatsuya; Matsuura, Kou

doi:10.1002/ccr3.3342

Cited by 4 publications

(7 citation statements)

References 17 publications

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“…There are no known associations of direct central nervous system (CNS) infection or inflammation with the occurrence of MERS; rather, these changes are more likely to be caused by inflammatory changes in the setting of non-CNS infections [ 2 ]. Its presentation is often nonspecific, with the most common presenting neurological symptoms involving delirious behaviors, disturbances in consciousness, irritability, and even seizures [ 1 , 3 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…The most common causative infectious organisms associated with MERS are viruses, such as influenza A and B, rotavirus, adenovirus, respiratory syncytial virus (RSV), and HSV, with one documented case associated with COVID-19 infection [ 2 , 7 , 9 ]. Bacterial etiologies are reported less commonly, although reports of MERS in association with Escherichia coli O-157, Salmonella typhi , Streptococcus pneumoniae , and Legionella have been reported [ 1 , 3 , 9 , 10 ]. Our patient was ultimately diagnosed with MERS associated with a systemic MP infection.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, symptoms can vary in children, with those older than 5 years of age more commonly presenting with fever, chills, sore throat, and progressive cough; while children 5 years old and younger can present with atypical symptoms, such as the vomiting and diarrhea seen in our patient [ 14 ]. Despite infection being so rampant in the pediatric community, very few cases of MP-associated MERS in the United States have been reported relative to Eastern and Southern Asian countries such as China, Japan, and India [ 3 , 10 ]. This may, in part, be explained by the discrepancy in the prevalence of macrolide-resistant MP (MRMP) between these two regions, with a resistance rate of up to 80–90% in Eastern Asia compared with about 10% in the United States [ 4 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…The most common etiologies are thought to be related to seizures, metabolic changes, or infections. Most cases are associated with viral infections [ 3 ]. While cases linked to bacterial infections have been found in the literature, only a few cases of MERS associated with Mycoplasma pneumoniae (MP) have been reported.…”

Section: Introductionmentioning

confidence: 99%

“…While cases linked to bacterial infections have been found in the literature, only a few cases of MERS associated with Mycoplasma pneumoniae (MP) have been reported. Of those found in the literature, most are reported in Eastern Asian countries [ 4 ], with only a handful reported in North America [ 1 , 3 ]. MP is an atypical bacterium responsible for a significant proportion of respiratory tract infections in children [ 5 ], and is found to be responsible for up to 10% of pediatric encephalitis cases [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Mild encephalitis/encephalopathy with a reversible splenial lesion associated with systemic Mycoplasma pneumoniae infection in North America: a case report

2022

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Background Mild encephalitis/encephalopathy with reversible splenial lesion is a clinical-radiological entity found to occur in the setting of an acute systemic inflammatory state with isolated lesions of the splenium of the corpus callosum and mild encephalopathy. Mild encephalitis/encephalopathy with reversible splenial lesion is commonly found to occur in children in the setting of viral infections. It has rarely been associated with Mycoplasma pneumoniae in the United States, unlike in Eastern and Southern Asia where this is much more prominent. Case presentations A 5-year-old African-American boy with autism spectrum disorder presented to our emergency department with acute onset intractable vomiting, diarrhea, and abnormal tensing movements for 2 days, following a 6-day period of fatigue, fever, and spastic abdominal pain. Emergent work-up in our department ruled out acute gastrointestinal pathologies. Given the high fevers and encephalopathy, there was concern for meningitis or encephalitis. His cerebrospinal fluid profile was concerning for viral meningitis, however extensive infectious workup was negative. Magnetic resonance imaging of his brain demonstrated a T2 fluid-attenuated inversion recovery sequence hyperintensity in the splenium of the corpus callosum, read as postictal changes by radiology. Continuous video electroencephalography demonstrated mild diffuse encephalopathy without electrographic correlate of his tensing episodes. He was determined to have mild encephalitis/encephalopathy with a reversible splenial lesion in the setting of a postinfectious etiology. He was treated with a single pulse-dose of intravenous methylprednisolone, following which he gradually returned to his baseline the next day. Repeat magnetic resonance imaging and cerebrospinal fluid evaluation demonstrated resolution of previous findings. He was ultimately diagnosed with an acute M. pneumoniae infection, which was determined to be the etiology of his mild encephalitis/encephalopathy with a reversible splenial lesion. Conclusions The presentation of mild encephalitis/encephalopathy with a reversible splenial lesion is often nonspecific, with behavioral symptoms ranging from irritability to disturbances in consciousness. Its prevalence is higher in the pediatric population, and is thought to be more of an infection-associated encephalopathy syndrome in this group. The infections are typically viral, more so than bacterial. M. pneumoniae, a small, atypical bacterium lacking a peptidoglycan cell wall, is a common respiratory tract pathogen found in children. Despite infection being so rampant in the pediatric community, very few cases of M. pneumoniae-associated mild encephalitis/encephalopathy with a reversible splenial lesion in the United States have been reported. In Eastern and Southern Asian countries, however, M. pneumoniae-associated mild encephalitis/encephalopathy with a reversible splenial lesion is much more commonly reported. This difference may potentially lie in the prevalence of macrolide-resistant M. pneumoniae, which is significantly higher in Asian countries given more liberal antibiotic use in M. pneumoniae infections. Infections with macrolide-resistant M. pneumoniae are reportedly greater in severity and duration. This amplified state may suggest a correlation between intensity of inflammatory response and the development of mild encephalitis/encephalopathy with a reversible splenial lesion. Given the rarity of M. pneumoniae-associated mild encephalitis/encephalopathy with a reversible splenial lesion in the United States, much remains unknown regarding predilection and optimum treatment strategy. As rates of macrolide-resistant M. pneumoniae begin to rise in the United States, maintaining a high level of suspicion remains key in better understanding this unique phenomenon.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Mild encephalitis/encephalopathy with a reversible splenial lesion associated with systemic Mycoplasma pneumoniae infection in North America: a case report

2022

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Atypical case of mild encephalopathy/encephalitis with reversible splenial lesion of the corpus callosum (MERS) associated withMycoplasma pneumoniaeinfection in a paediatric patient

Akbar

Ahmad

2021

BMJ Case Rep

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Mild encephalopathy with reversible splenial lesion (MERS) is a disorder characterised by prodromal symptoms such as fever, cough, vomiting or diarrhoea, followed by mild encephalopathy 1–7 days later with a documented reversible corpus callosum splenial lesion. MERS is mostly reported in children in the region of East Asia. To the best of our knowledge, this is the first reported case of MERS associated with mycoplasma infection in a child in North America. A brief review of literature is also a part of this report.

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Japanese Spotted Fever Associated with Mild Encephalitis/Encephalopathy with a Reversible Splenial Lesion

et al. 2023

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A 58-year-old woman had disseminated intravascular coagulation (DIC) and septic shock caused by Japanese spotted fever (JSF). Following treatment with minocycline, her general condition gradually improved; however, her disorientation persisted. Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) type II was diagnosed based on brain magnetic resonance imaging (MRI) showing a hyperintense area in the splenium of the corpus callosum and bilateral cerebral white matter on diffusion-weighted imaging. Thereafter, her consciousness gradually improved, but she continued to experience difficulty concentrating and attention deficits. MERS type II may take longer to improve than type I, and long-term follow-up is required.

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Clinically mild encephalitis/encephalopathy with reversible splenial lesion (MERS) associated with Mycoplasma pneumoniae pneumonia: An adult case and review of the literature

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 4 publications

References 17 publications

Mild encephalitis/encephalopathy with a reversible splenial lesion associated with systemic Mycoplasma pneumoniae infection in North America: a case report

Mild encephalitis/encephalopathy with a reversible splenial lesion associated with systemic Mycoplasma pneumoniae infection in North America: a case report

Atypical case of mild encephalopathy/encephalitis with reversible splenial lesion of the corpus callosum (MERS) associated withMycoplasma pneumoniaeinfection in a paediatric patient

Japanese Spotted Fever Associated with Mild Encephalitis/Encephalopathy with a Reversible Splenial Lesion

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