Karampatsas Konstantinos, Patel Himanshu, Basheer Sheikh N, Prendergast Andrew J
Department of Paediatrics, The Royal London Hospital, Barts Health NHS Trust, London, UK.
Department of Ophthalmology, The Royal London Hospital, Barts Health NHS Trust, London, UK Moorfields Eye Hospital, London, UK.
BMJ Case Rep. 2014 Dec 23;2014:bcr2014207041. doi: 10.1136/bcr-2014-207041.
A previously well 12-year-old boy presented with a 2-week history of headache, nausea, vomiting and left-sided weakness. He subsequently developed meningism, right abducens nerve palsy, persistent papilloedema and reduced visual acuity in association with a bilateral macular star, consistent with neuroretinitis. Cerebrospinal fluid (CSF) examination indicated chronic meningitis and serological testing confirmed recent Mycoplasma pneumoniae infection, although PCR in CSF was negative. He was treated for aseptic meningitis with ceftriaxone, aciclovir, azithromycin and acetazolamide for intracranial hypertension, with gradual improvement in clinical condition and visual acuity over several weeks. This is the first report of M. pneumoniae chronic meningitis further complicated with bilateral neuroretinitis and intracranial hypertension. Evidence of central nervous system inflammation in the absence of direct infection suggests an immune-mediated pathophysiology. Although the use of macrolides with antibiotic and immunomodulatory activity might be beneficial, it was not possible to ascertain whether it influenced clinical recovery in this case.
一名此前健康的12岁男孩出现了为期2周的头痛、恶心、呕吐和左侧肢体无力症状。随后，他出现了脑膜刺激征、右侧展神经麻痹、持续性视乳头水肿以及视力下降，并伴有双侧黄斑星芒状渗出，符合神经视网膜炎表现。脑脊液（CSF）检查提示慢性脑膜炎，血清学检测证实近期有肺炎支原体感染，尽管脑脊液中的聚合酶链反应（PCR）结果为阴性。他接受了头孢曲松、阿昔洛韦、阿奇霉素治疗无菌性脑膜炎，并使用乙酰唑胺治疗颅内高压，数周内临床症状和视力逐渐改善。这是首例肺炎支原体慢性脑膜炎并发双侧神经视网膜炎和颅内高压的报告。在无直接感染情况下出现中枢神经系统炎症的证据提示存在免疫介导的病理生理机制。尽管使用具有抗生素和免疫调节活性的大环内酯类药物可能有益，但无法确定其是否影响了本例的临床恢复情况。
