Ding Ann, Shen Burton, Elliott Sarah, Joshi Khushbu, Coghlin Daniel, McLaughlin Suzanne
Medical Resident in Internal Medicine-Pediatrics at Brown University.
Medical Resident in Pediatrics, Psychiatry, and Child and Adolescent Psychiatry at Brown University.
R I Med J (2013). 2020 Apr 1;103(3):59-62.
A 10-year-old male with T1DM and recent travel to North Carolina presented to an ED with 1 day of fever, vomiting, and headaches. He was discharged home with the presumptive diagnosis of viral gastroenteritis but returned nine hours later, agitated, and unable to speak. CSF showed pleocytosis. MRI brain was normal, and EEG showed intermittent seizures. He was started on antiepileptics. Antibiotics were discontinued after negative bacterial work-up. Repeat MRI brain one week later showed enhancement in the left cerebral cortex. IVIG was started due to concern for autoimmune encephalitis. Repeat lumbar puncture was positive for La Crosse virus IgM.
This is the first case of La Crosse encephalitis (LACe) reported in Rhode Island.1 La Crosse virus (LACv) is a ssRNA Bunyavirus transmitted by the eastern tree-hole mosquito typically between July and September. LACv is endemic to the upper Midwestern US and Appalachia. In 2018, 81 of 86 total cases reported by the CDC were pediatric. Children are more likely to present with vomiting, seizures, and focal cortical inflammation or cerebral edema on brain imaging. IgM may be negative early in the disease course. Treatment is antiepileptics and supportive care.
一名10岁男性，患有1型糖尿病，近期去过北卡罗来纳州，因发热、呕吐和头痛1天就诊于急诊室。他被诊断为病毒性肠胃炎后出院，但9小时后返回，烦躁不安且无法说话。脑脊液显示细胞增多。脑部磁共振成像（MRI）正常，脑电图显示间歇性癫痫发作。他开始使用抗癫痫药物治疗。细菌检查结果为阴性后停用抗生素。一周后复查脑部MRI显示左侧大脑皮质强化。因怀疑自身免疫性脑炎开始使用静脉注射免疫球蛋白（IVIG）。重复腰椎穿刺检测到拉克罗斯病毒IgM呈阳性。
这是罗德岛州报告的首例拉克罗斯脑炎（LACe）病例。拉克罗斯病毒（LACv）是一种单链RNA布尼亚病毒，由东部树洞蚊传播，通常在7月至9月间传播。LACv在美国中西部上游地区和阿巴拉契亚地区为地方性流行。2018年，美国疾病控制与预防中心（CDC）报告的86例病例中有81例为儿童。儿童在脑部成像时更易出现呕吐、癫痫发作以及局灶性皮质炎症或脑水肿。在疾病早期，IgM可能为阴性。治疗方法为使用抗癫痫药物并给予支持性护理。
