Department of Pediatrics, Hiraiwa Hospital, Japan.
J Neurol Sci. 2012 Sep 15;320(1-2):145-8. doi: 10.1016/j.jns.2012.06.010. Epub 2012 Jul 12.
Encephalitis/encephalopathy is a rare, but severe, complication of pertussis. Here, we report a case of an unimmunized 7-year-old boy with confirmed pertussis complicated by acute encephalitis/encephalopathy. Eighteen days after the onset of pertussis, generalized seizures began. Magnetic resonance imaging (MRI) indicated that marked demyelination without cytotoxic edema may have occurred to the patient. Notably, this is the first report to show precise MRI findings of pertussis-associated encephalitis/encephalopathy. Markedly increased myelin basic protein levels in the cerebrospinal fluid were consistent with the MRI findings. There was no evidence of direct invasion of the causative bacterium or its products into the central nervous system. The levels of interleukin-6 and -10 in the cerebrospinal fluid were higher than those in serum. Taken together, we conclude that indirect immune-mediated mechanisms may have contributed to the pathogenesis of the encephalitis/encephalopathy.
脑炎/脑病是百日咳的一种罕见但严重的并发症。在这里，我们报告了一例未免疫的 7 岁男孩，他患有确诊的百日咳并伴有急性脑炎/脑病。在百日咳发病后 18 天，开始出现全身性癫痫发作。磁共振成像（MRI）表明，患者可能发生了明显的脱髓鞘而无细胞毒性水肿。值得注意的是，这是首例显示与百日咳相关脑炎/脑病的精确 MRI 发现的报告。脑脊液中髓鞘碱性蛋白水平显著升高与 MRI 结果一致。没有证据表明病原体或其产物直接侵犯中枢神经系统。脑脊液中白细胞介素 6 和白细胞介素 10 的水平高于血清。综上所述，我们认为间接免疫介导机制可能导致了脑炎/脑病的发病。
