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Clinically mild encephalitis/encephalopathy with a reversible splenial lesion caused by methicillin-sensitive Staphylococcus aureus bacteremia with toxic shock syndrome: a case report.

Kosami K, Kenzaka T, Sagara Y, Minami K, Matsumura M - BMC Infect. Dis. (2016)

Bottom Line: The lesion in the SCC completely disappeared on MRI 7 days after disease onset.We diagnosed this case as MERS caused by S. aureus bacteremia with TSS.This is the first report of such a case, and we suggest that when a TSS patient presents with neurological symptoms, the possibility of MERS should be considered.

View Article: PubMed Central - PubMed

Affiliation: Division of General Internal Medicine, Jichi Medical University Hospital, Shimotsuke, Japan.

ABSTRACT

Background: Clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a mild encephalopathy caused by various pathological processes, but encephalopathy due to bacteria is rare.

Case presentation: We report the case of a 45-year-old Japanese woman who on receiving chemotherapy for advanced breast cancer developed an altered mental status and dysarthria soon after fever from infection of a subcutaneous implantable port. Staphylococcus aureus was detected in her blood cultures. Magnetic resonance imaging (MRI) revealed an ovoid lesion in the central portion of the splenium of the corpus callosum (SCC). Although hypotension was not observed, we diagnosed probable toxic shock syndrome (TSS) based on fever (temperature: >38.9 °C), altered mental status, erythema, desquamation, thrombocytopenia, liver dysfunction, and creatine phosphokinase elevation. We administered antimicrobial therapy and her neurological symptoms improved gradually. The lesion in the SCC completely disappeared on MRI 7 days after disease onset.

Conclusions: We diagnosed this case as MERS caused by S. aureus bacteremia with TSS. This is the first report of such a case, and we suggest that when a TSS patient presents with neurological symptoms, the possibility of MERS should be considered.

No MeSH data available.


Related in: MedlinePlus

Patient's clinical course after hospitalization. Abbreviations: MSSA, methicillin-sensitive Staphylococcus aureus; magnetic resonance imaging, MRI
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Fig3: Patient's clinical course after hospitalization. Abbreviations: MSSA, methicillin-sensitive Staphylococcus aureus; magnetic resonance imaging, MRI

Mentions: Figure 3 shows the clinical course post admission. Transesophageal echocardiography revealed no abnormalities. Moreover, septic emboli were not detected by enhanced computed tomography of the neck, chest, abdomen, and pelvis. We continued antibiotic therapy for 4 weeks after the blood cultures tested negative, i.e., after hospital day 4. At the 6-month follow up, no recurrence was noted.Fig. 3


Clinically mild encephalitis/encephalopathy with a reversible splenial lesion caused by methicillin-sensitive Staphylococcus aureus bacteremia with toxic shock syndrome: a case report.

Kosami K, Kenzaka T, Sagara Y, Minami K, Matsumura M - BMC Infect. Dis. (2016)

Patient's clinical course after hospitalization. Abbreviations: MSSA, methicillin-sensitive Staphylococcus aureus; magnetic resonance imaging, MRI
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4836078&req=5

Fig3: Patient's clinical course after hospitalization. Abbreviations: MSSA, methicillin-sensitive Staphylococcus aureus; magnetic resonance imaging, MRI
Mentions: Figure 3 shows the clinical course post admission. Transesophageal echocardiography revealed no abnormalities. Moreover, septic emboli were not detected by enhanced computed tomography of the neck, chest, abdomen, and pelvis. We continued antibiotic therapy for 4 weeks after the blood cultures tested negative, i.e., after hospital day 4. At the 6-month follow up, no recurrence was noted.Fig. 3

Bottom Line: The lesion in the SCC completely disappeared on MRI 7 days after disease onset.We diagnosed this case as MERS caused by S. aureus bacteremia with TSS.This is the first report of such a case, and we suggest that when a TSS patient presents with neurological symptoms, the possibility of MERS should be considered.

View Article: PubMed Central - PubMed

Affiliation: Division of General Internal Medicine, Jichi Medical University Hospital, Shimotsuke, Japan.

ABSTRACT

Background: Clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a mild encephalopathy caused by various pathological processes, but encephalopathy due to bacteria is rare.

Case presentation: We report the case of a 45-year-old Japanese woman who on receiving chemotherapy for advanced breast cancer developed an altered mental status and dysarthria soon after fever from infection of a subcutaneous implantable port. Staphylococcus aureus was detected in her blood cultures. Magnetic resonance imaging (MRI) revealed an ovoid lesion in the central portion of the splenium of the corpus callosum (SCC). Although hypotension was not observed, we diagnosed probable toxic shock syndrome (TSS) based on fever (temperature: >38.9 °C), altered mental status, erythema, desquamation, thrombocytopenia, liver dysfunction, and creatine phosphokinase elevation. We administered antimicrobial therapy and her neurological symptoms improved gradually. The lesion in the SCC completely disappeared on MRI 7 days after disease onset.

Conclusions: We diagnosed this case as MERS caused by S. aureus bacteremia with TSS. This is the first report of such a case, and we suggest that when a TSS patient presents with neurological symptoms, the possibility of MERS should be considered.

No MeSH data available.


Related in: MedlinePlus