Foo Jen Chun, Rahmat Kartini, Mumin Nazimah Ab, Koh Mia Tuang, Gan Chin Seng, Ramli Norlisah, Fong Choong Yi
Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Biomedical Imaging Department, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
J Clin Neurosci. 2017 Nov;45:155-157. doi: 10.1016/j.jocn.2017.08.024. Epub 2017 Sep 1.
We report a rare case of paediatric diphtheria complicated with encephalitis. A 6-year-old boy who did not receive his scheduled diptheria-tetanus-pertusis vaccination presented with one episode of generalised convulsive seizure. His illness was preceded by a 3day history of fever associated with enlarged exudative tonsils with a pseudomembrane. He was commenced on intravenous penicillin and oral erythromycin. However, he developed progressive encephalopathy with focal neurological deficit which required intubation on day 5 of illness. Throat swab polymerase chain reaction for diphtheria toxin A and B were positive and diphtheria antitoxin was given. Magnetic resonance imaging (MRI) of brain showed T2-weighted hyperintensities over the anterior cingulate gyri, insular cortex and cerebellum. This is the first reported MRI finding of diphtheric encephalitis. Our report highlights the importance of neuroimaging in diagnosing diphtheric encephalitis particularly in cases with unremarkable cerebrospinal findings.
我们报告了一例罕见的小儿白喉并发脑炎病例。一名6岁男孩未按计划接种白喉-破伤风-百日咳疫苗，出现了一次全身性惊厥发作。他在发病前有3天发热史，伴有渗出性扁桃体肿大及假膜。开始给予静脉注射青霉素和口服红霉素治疗。然而，他发展为进行性脑病并伴有局灶性神经功能缺损，在患病第5天需要插管。白喉毒素A和B的咽拭子聚合酶链反应呈阳性，并给予了白喉抗毒素。脑部磁共振成像（MRI）显示扣带回前部、岛叶皮质和小脑的T2加权高信号。这是首次报道的白喉性脑炎的MRI表现。我们的报告强调了神经影像学在诊断白喉性脑炎中的重要性，特别是在脑脊液检查结果不明显的病例中。
