Mild encephalopathy with a reversible splenial lesion in a girl with acute pyelonephritis.
Identifieur interne : 000959 ( PubMed/Corpus ); précédent : 000958; suivant : 000960Mild encephalopathy with a reversible splenial lesion in a girl with acute pyelonephritis.
Auteurs : Jung Sook Yeom ; Chung Mo Koo ; Ji Sook Park ; Ji-Hyun Seo ; Eun Sil Park ; Jae-Young Lim ; Hyang-Ok Woo ; Hee-Shang YounSource :
- Korean journal of pediatrics [ 1738-1061 ] ; 2018.
Abstract
We report the case of a 12-year-old girl who had mild encephalopathy with a reversible splenial lesion (MERS) associated with acutepyelonephritis caused by Escherichia coli. The patient was admitted with a high fever, and she was diagnosed with acute pyelonephritis based on pyuria and the results of urine culture, which detected cefotaxime-sensitive E. coli. Although intravenous cefotaxime and tobramycin were administered, her fever persisted and her C-reactive protein level increased to 307 mg/L. On day 3 of admission, she demonstrated abnormal neuropsychiatric symptoms, such as delirium, ataxia, and word salad. Magnetic resonance imaging (MRI) of the brain performed on day 4 showed marked hyperintensities in the bilateral corpus callosum and deep white matter on diffusion-weighted images, with corresponding diffusion restriction on apparent diffusion coefficient mapping. No abnormalities or pathogens were detected in the cerebrospinal fluid; however, lipopolysaccharides (LPS, endotoxin) were detected in plasma (41.6 pg/mL), associated with acute neurological deterioration. Her clinical condition gradually improved, and no neurological abnormalities were observed on day 6. Follow-up brain MRI performed 2 weeks later showed near-disappearance of the previously noted hyperintense lesions. In this patient, we first proved endotoxemia in a setting of MERS. The release of LPS following antibiotic administration might be related to the development of MERS in this patient. The possibility of MERS should be considered in patients who present with acute pyelonephritis and demonstrate delirious behavior.
DOI: 10.3345/kjp.2018.61.2.64
PubMed: 29563947
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Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Seo, Ji Hyun" sort="Seo, Ji Hyun" uniqKey="Seo J" first="Ji-Hyun" last="Seo">Ji-Hyun Seo</name><affiliation><nlm:affiliation>Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Park, Eun Sil" sort="Park, Eun Sil" uniqKey="Park E" first="Eun Sil" last="Park">Eun Sil Park</name><affiliation><nlm:affiliation>Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Lim, Jae Young" sort="Lim, Jae Young" uniqKey="Lim J" first="Jae-Young" last="Lim">Jae-Young Lim</name><affiliation><nlm:affiliation>Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Woo, Hyang Ok" sort="Woo, Hyang Ok" uniqKey="Woo H" first="Hyang-Ok" last="Woo">Hyang-Ok Woo</name><affiliation><nlm:affiliation>Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Youn, Hee Shang" sort="Youn, Hee Shang" uniqKey="Youn H" first="Hee-Shang" last="Youn">Hee-Shang Youn</name><affiliation><nlm:affiliation>Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2018">2018</date><idno type="RBID">pubmed:29563947</idno><idno type="pmid">29563947</idno><idno type="doi">10.3345/kjp.2018.61.2.64</idno><idno type="wicri:Area/PubMed/Corpus">000959</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000959</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Mild encephalopathy with a reversible splenial lesion in a girl with acute pyelonephritis.</title><author><name sortKey="Yeom, Jung Sook" sort="Yeom, Jung Sook" uniqKey="Yeom J" first="Jung Sook" last="Yeom">Jung Sook Yeom</name><affiliation><nlm:affiliation>Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Koo, Chung Mo" sort="Koo, Chung Mo" uniqKey="Koo C" first="Chung Mo" last="Koo">Chung Mo Koo</name><affiliation><nlm:affiliation>Department of Pediatrics, Changwon Gyeongsang National University Hospital, Changwon, Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Park, Ji Sook" sort="Park, Ji Sook" uniqKey="Park J" first="Ji Sook" last="Park">Ji Sook Park</name><affiliation><nlm:affiliation>Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Seo, Ji Hyun" sort="Seo, Ji Hyun" uniqKey="Seo J" first="Ji-Hyun" last="Seo">Ji-Hyun Seo</name><affiliation><nlm:affiliation>Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Park, Eun Sil" sort="Park, Eun Sil" uniqKey="Park E" first="Eun Sil" last="Park">Eun Sil Park</name><affiliation><nlm:affiliation>Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Lim, Jae Young" sort="Lim, Jae Young" uniqKey="Lim J" first="Jae-Young" last="Lim">Jae-Young Lim</name><affiliation><nlm:affiliation>Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Woo, Hyang Ok" sort="Woo, Hyang Ok" uniqKey="Woo H" first="Hyang-Ok" last="Woo">Hyang-Ok Woo</name><affiliation><nlm:affiliation>Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Youn, Hee Shang" sort="Youn, Hee Shang" uniqKey="Youn H" first="Hee-Shang" last="Youn">Hee-Shang Youn</name><affiliation><nlm:affiliation>Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Korean journal of pediatrics</title><idno type="ISSN">1738-1061</idno><imprint><date when="2018" type="published">2018</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">We report the case of a 12-year-old girl who had mild encephalopathy with a reversible splenial lesion (MERS) associated with acutepyelonephritis caused by <i>Escherichia coli</i>. The patient was admitted with a high fever, and she was diagnosed with acute pyelonephritis based on pyuria and the results of urine culture, which detected cefotaxime-sensitive <i>E. coli</i>. Although intravenous cefotaxime and tobramycin were administered, her fever persisted and her C-reactive protein level increased to 307 mg/L. On day 3 of admission, she demonstrated abnormal neuropsychiatric symptoms, such as delirium, ataxia, and word salad. Magnetic resonance imaging (MRI) of the brain performed on day 4 showed marked hyperintensities in the bilateral corpus callosum and deep white matter on diffusion-weighted images, with corresponding diffusion restriction on apparent diffusion coefficient mapping. No abnormalities or pathogens were detected in the cerebrospinal fluid; however, lipopolysaccharides (LPS, endotoxin) were detected in plasma (41.6 pg/mL), associated with acute neurological deterioration. Her clinical condition gradually improved, and no neurological abnormalities were observed on day 6. Follow-up brain MRI performed 2 weeks later showed near-disappearance of the previously noted hyperintense lesions. In this patient, we first proved endotoxemia in a setting of MERS. The release of LPS following antibiotic administration might be related to the development of MERS in this patient. The possibility of MERS should be considered in patients who present with acute pyelonephritis and demonstrate delirious behavior.</div></front></TEI><pubmed><MedlineCitation Status="PubMed-not-MEDLINE" Owner="NLM"><PMID Version="1">29563947</PMID><DateRevised><Year>2019</Year><Month>11</Month><Day>20</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Print">1738-1061</ISSN><JournalIssue CitedMedium="Print"><Volume>61</Volume><Issue>2</Issue><PubDate><Year>2018</Year><Month>Feb</Month></PubDate></JournalIssue><Title>Korean journal of pediatrics</Title><ISOAbbreviation>Korean J Pediatr</ISOAbbreviation></Journal><ArticleTitle>Mild encephalopathy with a reversible splenial lesion in a girl with acute pyelonephritis.</ArticleTitle><Pagination><MedlinePgn>64-67</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.3345/kjp.2018.61.2.64</ELocationID><Abstract><AbstractText>We report the case of a 12-year-old girl who had mild encephalopathy with a reversible splenial lesion (MERS) associated with acutepyelonephritis caused by <i>Escherichia coli</i>. The patient was admitted with a high fever, and she was diagnosed with acute pyelonephritis based on pyuria and the results of urine culture, which detected cefotaxime-sensitive <i>E. coli</i>. Although intravenous cefotaxime and tobramycin were administered, her fever persisted and her C-reactive protein level increased to 307 mg/L. On day 3 of admission, she demonstrated abnormal neuropsychiatric symptoms, such as delirium, ataxia, and word salad. Magnetic resonance imaging (MRI) of the brain performed on day 4 showed marked hyperintensities in the bilateral corpus callosum and deep white matter on diffusion-weighted images, with corresponding diffusion restriction on apparent diffusion coefficient mapping. No abnormalities or pathogens were detected in the cerebrospinal fluid; however, lipopolysaccharides (LPS, endotoxin) were detected in plasma (41.6 pg/mL), associated with acute neurological deterioration. Her clinical condition gradually improved, and no neurological abnormalities were observed on day 6. Follow-up brain MRI performed 2 weeks later showed near-disappearance of the previously noted hyperintense lesions. In this patient, we first proved endotoxemia in a setting of MERS. The release of LPS following antibiotic administration might be related to the development of MERS in this patient. The possibility of MERS should be considered in patients who present with acute pyelonephritis and demonstrate delirious behavior.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Yeom</LastName><ForeName>Jung Sook</ForeName><Initials>JS</Initials><AffiliationInfo><Affiliation>Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Gyeongsang Institute of Health Science, Jinju, Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Koo</LastName><ForeName>Chung Mo</ForeName><Initials>CM</Initials><AffiliationInfo><Affiliation>Department of Pediatrics, Changwon Gyeongsang National University Hospital, Changwon, Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Park</LastName><ForeName>Ji Sook</ForeName><Initials>JS</Initials><AffiliationInfo><Affiliation>Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Gyeongsang Institute of Health Science, Jinju, Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Seo</LastName><ForeName>Ji-Hyun</ForeName><Initials>JH</Initials><AffiliationInfo><Affiliation>Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Gyeongsang Institute of Health Science, Jinju, Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Park</LastName><ForeName>Eun Sil</ForeName><Initials>ES</Initials><AffiliationInfo><Affiliation>Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Gyeongsang Institute of Health Science, Jinju, Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lim</LastName><ForeName>Jae-Young</ForeName><Initials>JY</Initials><AffiliationInfo><Affiliation>Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Gyeongsang Institute of Health Science, Jinju, Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Woo</LastName><ForeName>Hyang-Ok</ForeName><Initials>HO</Initials><AffiliationInfo><Affiliation>Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Gyeongsang Institute of Health Science, Jinju, Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Youn</LastName><ForeName>Hee-Shang</ForeName><Initials>HS</Initials><AffiliationInfo><Affiliation>Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Gyeongsang Institute of Health Science, Jinju, Korea.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2018</Year><Month>02</Month><Day>28</Day></ArticleDate></Article><MedlineJournalInfo><Country>Korea (South)</Country><MedlineTA>Korean J Pediatr</MedlineTA><NlmUniqueID>101215374</NlmUniqueID><ISSNLinking>1738-1061</ISSNLinking></MedlineJournalInfo><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Corpus callosum</Keyword><Keyword MajorTopicYN="N">Encephalopathy</Keyword><Keyword MajorTopicYN="N">Escherichia coli</Keyword><Keyword MajorTopicYN="N">Pyelonephritis</Keyword><Keyword MajorTopicYN="N">White matter</Keyword></KeywordList><CoiStatement>Conflicts of interest: No potential conflict of interest relevant to this article was reported.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2017</Year><Month>09</Month><Day>05</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2017</Year><Month>10</Month><Day>22</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2017</Year><Month>10</Month><Day>31</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2018</Year><Month>3</Month><Day>23</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2018</Year><Month>3</Month><Day>23</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2018</Year><Month>3</Month><Day>23</Day><Hour>6</Hour><Minute>1</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">29563947</ArticleId><ArticleId IdType="doi">10.3345/kjp.2018.61.2.64</ArticleId><ArticleId 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