Post-infective transverse myelitis following Streptococcus pneumoniae meningitis with radiological features of acute disseminated encephalomyelitis: a case report

Williams, Thomas; Thorpe, John

doi:10.1186/1752-1947-6-313

Cited by 10 publications

(6 citation statements)

References 17 publications

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“…Some reports point out the possibility of infectious or postinfectious myelitis, especially bacterial myelitis 11 12. On admission, our patient presented none of the classic signs of meningeal irritations such as fever, neck stiffness, altered mental status (GCS<13), or headache.…”

Section: Discussionmentioning

confidence: 65%

Longitudinally extensive transverse myelitis with anti-NMDA receptor antibodies during a systemic lupus erythematosus flare-up

et al. 2015

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Transverse myelitis (TM) with systemic lupus erythematosus (SLE) has been linked to the presence of autoantibodies (eg, antiaquaporin 4 (AQP4) and anticardiolipin (aCL)) and SLE-induced secondary vasculitis, but the aetiology remains incompletely understood. A 48-year-old Japanese man with a 6-year history of poorly controlled SLE had stopped glucocorticoid therapy 1 year before admission. 3 days before admission, he developed flaccid paraplegia. Spinal MRI showed a longitudinally hyperintense T2 grey matter lesion from the level of Th4 to the conus medullaris, which was considered longitudinally extensive TM (LETM). We administered steroid pulse therapy (methyl-prednisolone 1000 mg/day) for 3 days and prednisolone 50 mg/day. The patient's flaccid paralysis gradually improved. We concluded that the patient's TM was caused by SLE flare-up, even though we could not completely rule out antiphospholipid syndrome. SLE myelitis is relatively rare and many aetiologies are possible for TM in SLE.

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Section: Discussionmentioning

confidence: 65%

Longitudinally extensive transverse myelitis with anti-NMDA receptor antibodies during a systemic lupus erythematosus flare-up

et al. 2015

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“…The spinal symptoms appeared after two weeks of the patient's systemic symptoms; thus, it seems that the myelitis, in this case, is post-infectious, mainly because of normal CSF analysis without pleocytosis or lymphocytosis. This myelitis type occurs with numerous other viruses and bacteria by the immunologic reaction, not a straight attack of the virus to the spinal cord [9,13,14].…”

Section: Discussionmentioning

confidence: 99%

COVID-19-Associated Myelitis, Para/Post Infectious or Infectious Myelitis: A Case Report From the North of Iran

Saberi

Ghayeghran

Hatamian

et al. 2020

Caspian J Neurol Sci

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Background: During the COVID-19 pandemic, besides the most prevalent respiratory and systemic symptoms, some neurological symptoms such as acute hemorrhagic necrotizing encephalopathy and myelitis associated with COVID-19 have been reported. It is suspected that COVID-19 involves different body systems via interaction with the ACE-2 (angiotensin-converting enzyme 2) receptor. As ACE2 is expressed on the surface of central nervous system cells, including the brain and spine, these kinds of manifestations are inevitable. Clinical Presentation and Intervention: Here we report a case of COVID-19 associated with acute myelitis in an infected patient in the north of Iran during the pandemic of COVID-19. He presented with paraparesis and urinary incontinence. Unfortunately, he did not respond to anti-inflammatory treatment. Conclusion: Para/Post Infectious myelitis could be a complication of COVID-19 infection.

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“…All reported cases of ADEM following pneumococcal meningitis were treated with pulse doses of steroids for 3-10 days (Table 1), which proved to be effective. Another patient, following pneumococcal meningitis, was diagnosed with acute transverse myelitis associated with evidence of widespread white matter brain lesions, which though did not ful l the diagnostic criteria for ADEM; he was treated with high-dose steroids, with prompt recovery (50). In only one pediatric case steroids and IVIG were administered at the same time (31).…”

Section: Discussionmentioning

confidence: 99%

Acute Disseminated Encephal Omyelitis (ADEM) After Pneumococcal Meningitis In A Child

Foiadelli¹,

Trabatti²,

Bassanese³

et al. 2020

Preprint

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Background: Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder of the central nervous system (CNS), whose pathogenesis is still debated. It occurs more frequently in children, and the first neurological symptoms usually appear between 2 and 4 weeks after a trigger event, such as an infection or vaccination. Several viral agents have been related to the development of ADEM, while bacteria and parasites are less frequently involved. Severe Streptococcus pneumoniae infection has been rarely described as a trigger for CNS demyelination in particularly predisposed subjects.Case presentation: A 10 year old girl was evaluated for headache, fever and vomit. CSF analysis revealed pleocytosis and presence of S. pneumoniae antigen, and proper antibiotic therapy for bacterial meningitis was started, with rapid improvement. A breach in the right frontal bone, due to a car accident occurring the previous year, was considered the gateway for pneumococcal infection. Three days after admission, the girl developed drowsiness, altered speech and left hemiparesis. Brain MRI showed multiple T2-hyperintense bilateral lesions in the supratentorial white matter, and ADEM was diagnosed. Considering the underlying bacterial meningitis, intravenous immunoglobulins were preferred to steroid therapy, and the patient progressively recovered. However, due to recurrence of encephalopathic symptoms after 11 days, high-dose intravenous steroid therapy was performed. The neurological outcome was favourable, with complete regression of the white matter lesions after 4 months and absence of relapses over a follow-up period of 2 years.Conclusions: Occurrence of ADEM following pneumococcal meningitis is rare, and very few cases have been described in children. It should be suspected in case of persistence, recurrence or onset of new symptoms despite adequate antimicrobial treatment, relying on brain MRI for a thorough differential diagnosis. High level of surveillance is mandatory in patients with predisposing factors to invasive pneumococcal disease. In some cases, acute demyelination can occur few days after the onset of meningitis; pathogenetic mechanisms are not yet fully clarified and the choice of the correct therapeutic approach can be challenging.

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Post-infective transverse myelitis following Streptococcus pneumoniae meningitis with radiological features of acute disseminated encephalomyelitis: a case report

Cited by 10 publications

References 17 publications

Longitudinally extensive transverse myelitis with anti-NMDA receptor antibodies during a systemic lupus erythematosus flare-up

Longitudinally extensive transverse myelitis with anti-NMDA receptor antibodies during a systemic lupus erythematosus flare-up

COVID-19-Associated Myelitis, Para/Post Infectious or Infectious Myelitis: A Case Report From the North of Iran

Acute Disseminated Encephal Omyelitis (ADEM) After Pneumococcal Meningitis In A Child

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