Williams Thomas, Thorpe John
Addenbrooke's Hospital, University of Cambridge School of Clinical Medicine, Box 111, Hills Road, Cambridge, CB2 0SP, UK.
J Med Case Rep. 2012 Sep 19;6:313. doi: 10.1186/1752-1947-6-313.
Post-infectious autoimmune demyelination of the central nervous system is a rare neurological disorder typically associated with exanthematous viral infections. We report an unusual presentation of the condition and a previously undocumented association with Streptococcus pneumonia meningitis.
A 50-year-old Caucasian woman presented to our facility with an acute myelopathy three days after discharge following acute Streptococcus pneumoniae meningitis. Imaging studies of the spine ruled out an infective focus and no other lesions were seen within the cord. Diffuse, bilateral white matter lesions were seen within the cerebral hemispheres, and our patient was diagnosed as having a post-infective demyelination syndrome that met the diagnostic criteria for an acute transverse myelitis. Our patient clinically and radiologically improved following treatment with steroids.
The novel association of a Streptococcus pneumoniae infection with post-infectious autoimmune central nervous system demyelination should alert the reader to the potentially causative role of this common organism, and gives insights into the pathogenesis. The unusual dissociation between the clinical presentation and the location of the radiological lesions should also highlight the potential for the condition to mimic the presentation of others, and stimulates debate on the definitions of acute transverse myelitis and acute disseminated encephalomyelitis, and their potential overlap.
感染后中枢神经系统自身免疫性脱髓鞘是一种罕见的神经系统疾病，通常与发疹性病毒感染有关。我们报告了该疾病的一种不寻常表现以及与肺炎链球菌脑膜炎的一种既往未记录的关联。
一名50岁的白种女性在急性肺炎链球菌脑膜炎出院三天后因急性脊髓病前来我院就诊。脊柱影像学检查排除了感染灶，脊髓内未见其他病变。在大脑半球内可见弥漫性双侧白质病变，我们的患者被诊断为患有符合急性横贯性脊髓炎诊断标准的感染后脱髓鞘综合征。经类固醇治疗后，我们的患者在临床和影像学上均有改善。
肺炎链球菌感染与感染后自身免疫性中枢神经系统脱髓鞘的新关联应提醒读者注意这种常见病原体的潜在致病作用，并为发病机制提供见解。临床表现与放射学病变位置之间的异常分离也应凸显该疾病模仿其他疾病表现的可能性，并引发关于急性横贯性脊髓炎和急性播散性脑脊髓炎的定义及其潜在重叠的讨论。
