Kawasaki disease complicated by mild encephalopathy with a reversible splenial lesion (MERS)

Takanashi, Jun‐ichi; Shirai, Kentaro; Sugawara, Yuji; Okamoto, Yoko; Obonai, Toshimasa; Terada, Hitoshi

doi:10.1016/j.jns.2011.11.022

Cited by 49 publications

(45 citation statements)

References 16 publications

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“…of patientsPathogens of MERS in the literature (no. of patients)Hoshino et al [5]153Influenza (53), rotavirus (18), mumps virus (6), HHV-6 (3), bacterial infection (5)Takanashi et al [11]54Unknown (22), influenza A/B (6/4), mumps virus (4), adenovirus (3), rotavirus (3), streptococcus (3), Escherichia coli (3)Tada et al [10]15Unknown (10), influenza A (1), adenovirus (1), mumps virus (1), VZV virus (1)Bulakbasi et al [1]5Influenza A (5)Ganapathy et al [3]2Influenza B (2)Takanashi et al [13]4Kawasaki disease (4)…”

Section: Discussionmentioning

confidence: 99%

“…However, the exact reason for the development of MERS in patients with bacterial infection, as well as our patient, is unknown. Serum proinflammatory cytokines, including interleukin (IL)-1β, IL-6, and IL-8, and tumor necrosis factor-alpha are elevated in patients with acute pyelonephritis [4, 9], and Kawasaki disease, by which MERS is also complicated [13]. Therefore, activation of the immune system is likely to be associated with the pathogenesis of MERS.…”

Section: Discussionmentioning

confidence: 99%

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Clinically mild encephalitis/encephalopathy with a reversible splenial lesion associated with febrile urinary tract infection

et al. 2013

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Common pathogens of clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) are viruses, such as influenza virus. However, bacteria are rare pathogens for MERS. We report the first patient with MERS associated with febrile urinary tract infection. A 16-year-old lupus patient was admitted to our hospital. She had fever, headache, vomiting, and right back pain. Urinary analysis showed leukocyturia, and urinary culture identified Klebsiella pneumoniae. Cerebrospinal fluid examination and brain single-photon emission computed tomography showed no abnormalities. Therefore, she was diagnosed with febrile urinary tract infection. For further examinations, 99mTc-dimercaptosuccinic acid renal scintigraphy showed right cortical defects, and a voiding cystourethrogram demonstrated right vesicoureteral reflux (grade II). Therefore, she was diagnosed with right pyelonephritis. Although treatment with antibiotics administered intravenously improved the fever, laboratory findings, and right back pain, she had prolonged headaches, nausea, and vomiting. T2-weighted, diffusion-weighted, and fluid attenuated inversion recovery images in brain magnetic resonance imaging showed high intensity lesions in the splenium of the corpus callosum, which completely disappeared 1 week later. These results were compatible with MERS. To the best of our knowledge, our patient is the first patient who showed clinical features of MERS associated with febrile urinary tract infection. Conclusion: In patients with pyelonephritis and an atypical clinical course, such as prolonged headache, nausea, vomiting, and neurological disorders, the possibility of MERS should be considered.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinically mild encephalitis/encephalopathy with a reversible splenial lesion associated with febrile urinary tract infection

et al. 2013

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“…[39,40] At present, KD is considered to be immune-mediated vasculitis. Takanashi et al [38] reported 4 patients developed RESLES with KD. Researchers have found that the mechanism of RESLES in KD patients was incompletely clear.…”

Section: Discussionmentioning

confidence: 99%

“…Researchers have found that the mechanism of RESLES in KD patients was incompletely clear. [38] It had been found many proinflammatory cytokines and chemokines were elevated in patients with KD during the acute phase, such as tumor necrosis factor-α, interleukin 1, 6, 8, and vascular endothelial growth factor. [41–42] Proinflammatory cytokines and chemokines might contribute to the inflammatory infiltration which serves as a possible mechanism for transient restricted diffusion in cases of RESLES.…”

Section: Discussionmentioning

confidence: 99%

Reversible splenial lesion syndrome associated with lobar pneumonia

Wu²,

Qi³

et al. 2016

Medicine

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Background:Reversible splenial lesion syndrome (RESLES) is a rare clinico-radiological disorder with unclear pathophysiology. Clinically, RESLES is defined as reversible isolated splenial lesions in the corpus callosum, which can be readily identified by magnetic resonance imaging (MRI) and usually resolve completely over a period of time. RESLES could be typically triggered by infection, antiepileptic drugs (AEDs), poisoning, etc. More factors are increasingly recognized.Methods and results:We reported herein an 18-year-old female patient with lobar pneumonia who developed mental abnormalities during hospitalization. An isolated splenial lesion in the corpus callosum was found by head MRI and the lesion disappeared 15 days later. Based on her clinical manifestations and radiological findings, she was diagnosed with lobar pneumonia associated RESLES. We further summarize the up-to-date knowledge about the etiology, possible pathogenesis, clinical manifestations, radiological features, treatment, and prognosis of RESLES.Conclusion:This report contributes to the clinical understanding of RESLES which may present with mental abnormalities after infection. The characteristic imaging of reversible isolated splenial lesions in the corpus callosum was confirmed in this report. The clinical manifestations and lesions on MRI could disappear naturally after 1 month without special treatment.

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“…It is believed to be caused by infectious agents, host immune dysregulation, and genetic susceptibility. During the acute stage of KD, activation of vascular endothelial cells and increased serum levels of proinflammatory cytokines lead to inflammation and injury of blood vessels [6-8]. The vascular inflammation may induce the development of aneurysms and cardiac complications.…”

Section: Introductionmentioning

confidence: 99%

Sorting nexin 24 genetic variation associates with coronary artery aneurysm severity in Kawasaki disease patients

et al. 2013

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BackgroundThe sorting nexin (SNX) family is involved in endocytosis and protein trafficking and plays multiple roles in various diseases. The role of SNX proteins in Kawasaki disease (KD) is not known. We attempted to test whether genetic SNX variation associates with the risk of coronary artery aneurysm (CAA) formation in KD.Methods and resultsChi-square tests were used to identify SNX24 genetic variants associated with KD susceptibility and CAA formation in KD; models were adjusted for fever duration and time of first administration of intravenous immunoglobulin. We obtained clinical characteristics and genotypes from KD patients (76 with CAA and 186 without CAA) in a population-based retrospective KD cohort study (n = 262). Clinical and genetic factors were associated with CAA formation in KD. In addition, endothelial cell inflammation was evaluated. Significant correlation was observed between KD with CAA complications and the rs28891 single-nucleotide polymorphism in SNX24. Patients with CC + CT genotypes had lesser CAA complications. In lipopolysaccharide-treated human umbilical vein endothelial cells, siRNA knockdown of SNX24 significantly decreased gene expression of the proinflammatory cytokines IL-1 beta, IL-6, and IL-8.ConclusionsPolymorphisms in SNX24 may be used as genetic markers for the diagnosis and prognosis of CAA formation in KD.

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Kawasaki disease complicated by mild encephalopathy with a reversible splenial lesion (MERS)

Cited by 49 publications

References 16 publications

Clinically mild encephalitis/encephalopathy with a reversible splenial lesion associated with febrile urinary tract infection

Clinically mild encephalitis/encephalopathy with a reversible splenial lesion associated with febrile urinary tract infection

Reversible splenial lesion syndrome associated with lobar pneumonia

Sorting nexin 24 genetic variation associates with coronary artery aneurysm severity in Kawasaki disease patients

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