Yamaguchi Hiroshi, Nagase Hiroaki, Ito Yusuke, Matsunoshita Natsuki, Mizutani Makoto, Matsushige Takeshi, Ishida Yusuke, Toyoshima Daisaku, Kasai Masashi, Kurosawa Hiroshi, Maruyama Azusa, Iijima Kazumoto
Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan; Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
J Infect Chemother. 2018 Nov;24(11):932-935. doi: 10.1016/j.jiac.2018.04.007. Epub 2018 May 8.
Acute focal bacterial nephritis (AFBN) is a localized bacterial infection of the kidney presenting as an inflammatory mass, and some patients show deterioration of clinical condition with neurological symptoms. Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is a syndrome that is characterized by biphasic seizures and impaired consciousness with reduced diffusion in the subcortical white matter on magnetic resonance imaging, typically observed between days 3 and 9 after clinical onset. Although AFBN sometimes causes neurological symptoms, no cases of AFBN with AESD have been reported, and no studies have presented the cytokine profiles of patients with a severe form of acute encephalopathy with AFBN. We report here a very rare case involving a 6-month-old boy who developed AFBN due to Enterococcus faecalis with both the clinical and radiological features of AESD. In our patient, serum interleukin (IL)-6, IL-10, and interferon (IFN)-γ levels markedly increased on admission, and on day 4, only IL-6 levels significantly increased in the cerebrospinal fluid (CSF). These results suggest that high serum cytokines are produced locally in response to AFBN and elevated IL-6 levels in CSF may have neuroprotective roles.
急性局灶性细菌性肾炎（AFBN）是一种肾脏局部细菌感染，表现为炎性肿块，部分患者临床状况会恶化并出现神经症状。伴有双相性癫痫发作和晚期弥散受限的急性脑病（AESD）是一种综合征，其特征为双相性癫痫发作和意识障碍，磁共振成像显示皮质下白质弥散受限，通常在临床发病后3至9天出现。尽管AFBN有时会引起神经症状，但尚未有AFBN合并AESD的病例报道，也没有研究展示过患有严重形式急性脑病合并AFBN患者的细胞因子谱。我们在此报告一例非常罕见的病例，一名6个月大男孩因粪肠球菌感染发生AFBN，同时具备AESD的临床和影像学特征。在我们的患者中，入院时血清白细胞介素（IL）-6、IL-10和干扰素（IFN）-γ水平显著升高，第4天时，脑脊液（CSF）中仅IL-6水平显著升高。这些结果表明，高血清细胞因子是对AFBN的局部反应产生的，脑脊液中升高的IL-6水平可能具有神经保护作用。
