Limits...
Mycoplasma-induced minimally conscious state.

Horvath T, Fischer U, Müller L, Ott S, Bassetti CL, Wiest R, Sendi P, Schefold JC - Springerplus (2016)

Bottom Line: Despite early and targeted therapy using four different immunosuppressive strategies, clinical success was limited.Moreover, it can be fulminant and fatal in adults.Our case enhances the debate for an optimal antimicrobial agent with activity beyond the blood-brain barrier.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland.

ABSTRACT
Mycoplasma pneumoniae (M. pneumoniae) frequently causes community-acquired respiratory tract infection and often presents as atypical pneumonia. Following airborne infection and a long incubation period, affected patients mostly suffer from mild or even asymptomatic and self-limiting disease. In particular in school-aged children, M. pneumoniae is associated with a wide range of extrapulmonary manifestations including central nervous system (CNS) disease. In contrast to children, severe CNS manifestations are rarely observed in adults. We report a case of a 37 year-old previously healthy immunocompetent adult with fulminant M. pneumoniae-induced progressive encephalomyelitis who was initially able to walk to the emergency department. A few hours later, she required controlled mechanical ventilation for ascending transverse spinal cord syndrome, including complete lower extremity paraplegia. Severe M. pneumoniae-induced encephalomyelitis was postulated, and antimicrobial, anti-inflammatory and immunosuppressive therapy was applied on the intensive care unit. Despite early and targeted therapy using four different immunosuppressive strategies, clinical success was limited. In our patient, locked-in syndrome developed followed by persistent minimally conscious state. The neurological status was unchanged until day 230 of follow-up. Our case underlines that severe M. pneumoniae- related encephalomyelitis must not only be considered in children, but also in adults. Moreover, it can be fulminant and fatal in adults. Our case enhances the debate for an optimal antimicrobial agent with activity beyond the blood-brain barrier. Furthermore, it may underline the difficulty in clinical decision making regarding early antimicrobial treatment in M. pneumoniae disease, which is commonly self-limited.

No MeSH data available.


Related in: MedlinePlus

Baseline cerebral CT scan (upper left side) and cerebral and spinal MRI at days 1, 2, and 58, respectively
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4764598&req=5

Fig1: Baseline cerebral CT scan (upper left side) and cerebral and spinal MRI at days 1, 2, and 58, respectively

Mentions: On day 2, flaccid quadriplegia with complete areflexia and sensory loss (C3-level) developed. Communication was possible by means of head movement only. Finally, cranial nerve function diminished with only vertical eye movement preserved and locked-in syndrome was diagnosed. Repeated MRI demonstrated a diffusion restriction accompanied by predominantly subcortical T2-hyperintensities (along splenium/corpus callosum, inferior parietal lobe, brainstem) extending into the cervical spine (Fig. 1). Supported only by anecdotal data (Cotter et al. 1983), plasmapheresis for severe para-infectious encephalomyelitis was performed (five sessions QD, followed by five sessions QOD). With decreasing alertness, cyclophosphamide (1 g/dose, days 10 and 24) and infliximab (375 mg/m2, day 40) was administered without clinical effect. A corpus callosum biopsy revealed extensive demyelination, though PCR for M. pneumoniae was negative. A tracheostomy for long-term mechanical ventilation was performed on day 10 and moxifloxacin was continued for a total of 21 days. Prednisolone was progressively tapered and in the further course and the daily dosage at discharge was 25 mg.Fig. 1


Mycoplasma-induced minimally conscious state.

Horvath T, Fischer U, Müller L, Ott S, Bassetti CL, Wiest R, Sendi P, Schefold JC - Springerplus (2016)

Baseline cerebral CT scan (upper left side) and cerebral and spinal MRI at days 1, 2, and 58, respectively
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4764598&req=5

Fig1: Baseline cerebral CT scan (upper left side) and cerebral and spinal MRI at days 1, 2, and 58, respectively
Mentions: On day 2, flaccid quadriplegia with complete areflexia and sensory loss (C3-level) developed. Communication was possible by means of head movement only. Finally, cranial nerve function diminished with only vertical eye movement preserved and locked-in syndrome was diagnosed. Repeated MRI demonstrated a diffusion restriction accompanied by predominantly subcortical T2-hyperintensities (along splenium/corpus callosum, inferior parietal lobe, brainstem) extending into the cervical spine (Fig. 1). Supported only by anecdotal data (Cotter et al. 1983), plasmapheresis for severe para-infectious encephalomyelitis was performed (five sessions QD, followed by five sessions QOD). With decreasing alertness, cyclophosphamide (1 g/dose, days 10 and 24) and infliximab (375 mg/m2, day 40) was administered without clinical effect. A corpus callosum biopsy revealed extensive demyelination, though PCR for M. pneumoniae was negative. A tracheostomy for long-term mechanical ventilation was performed on day 10 and moxifloxacin was continued for a total of 21 days. Prednisolone was progressively tapered and in the further course and the daily dosage at discharge was 25 mg.Fig. 1

Bottom Line: Despite early and targeted therapy using four different immunosuppressive strategies, clinical success was limited.Moreover, it can be fulminant and fatal in adults.Our case enhances the debate for an optimal antimicrobial agent with activity beyond the blood-brain barrier.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland.

ABSTRACT
Mycoplasma pneumoniae (M. pneumoniae) frequently causes community-acquired respiratory tract infection and often presents as atypical pneumonia. Following airborne infection and a long incubation period, affected patients mostly suffer from mild or even asymptomatic and self-limiting disease. In particular in school-aged children, M. pneumoniae is associated with a wide range of extrapulmonary manifestations including central nervous system (CNS) disease. In contrast to children, severe CNS manifestations are rarely observed in adults. We report a case of a 37 year-old previously healthy immunocompetent adult with fulminant M. pneumoniae-induced progressive encephalomyelitis who was initially able to walk to the emergency department. A few hours later, she required controlled mechanical ventilation for ascending transverse spinal cord syndrome, including complete lower extremity paraplegia. Severe M. pneumoniae-induced encephalomyelitis was postulated, and antimicrobial, anti-inflammatory and immunosuppressive therapy was applied on the intensive care unit. Despite early and targeted therapy using four different immunosuppressive strategies, clinical success was limited. In our patient, locked-in syndrome developed followed by persistent minimally conscious state. The neurological status was unchanged until day 230 of follow-up. Our case underlines that severe M. pneumoniae- related encephalomyelitis must not only be considered in children, but also in adults. Moreover, it can be fulminant and fatal in adults. Our case enhances the debate for an optimal antimicrobial agent with activity beyond the blood-brain barrier. Furthermore, it may underline the difficulty in clinical decision making regarding early antimicrobial treatment in M. pneumoniae disease, which is commonly self-limited.

No MeSH data available.


Related in: MedlinePlus