Yamamoto Hisako, Miyamoto Yusaku, Shimizu Naoki
Division of Pediatrics, Kawasaki Municipal Tama Hospital.
Department of Pediatrics, St. Marianna University School of Medicine.
J Nippon Med Sch. 2023 Feb 1;89(6):640-644. doi: 10.1272/jnms.JNMS.2022_89-609. Epub 2021 Nov 26.
Acute encephalopathy is a syndrome characterized by an acute onset of disturbance of consciousness. Many acute encephalopathies are caused by viral infections; however, they can also be a result of bacterial infections. Acute focal bacterial nephritis (AFBN) can cause neurological symptoms, such as irritation, unconsciousness, and seizures. In some cases, AFBN-associated acute encephalopathy has also been reported. This report describes the first case of acute encephalopathy with AFBN without significant findings on brain MRI. The patient was a 3-year-old male, who had two episodes of febrile seizures at the ages of 1 and 2 years. He developed disturbance of consciousness, irritability, excitability, and neck stiffness on the day after admission. There were no abnormal findings on brain MRI; however, a generalized high-voltage slow wave was noted on electroencephalography (EEG). His urinary sediment count was elevated, and Morganella morganii and Enterococcus faecalis were detected in the urinary culture. A diagnosis of acute encephalopathy with urinary tract infection (UTI) was made. Intravenous (IV) antibiotics were administered to treat the UTI, while methylprednisolone pulse therapy and IV immunoglobulin were administered to treat acute encephalopathy. Additionally, AFBN was detected in both kidneys on contrast-enhanced CT. The patient received a second course of methylprednisolone pulse therapy due to the persistent high voltage slow wave noted on the EEG on day 8. Furthermore, contrast-enhanced CT revealed AFBN in both kidneys. The final diagnosis was acute encephalopathy with AFBN; however, we had initially diagnosed febrile seizures associated with UTI. It should be noted that acute encephalopathy is associated with AFBN.
急性脑病是一种以急性意识障碍为特征的综合征。许多急性脑病由病毒感染引起；然而，它们也可能是细菌感染的结果。急性局灶性细菌性肾炎（AFBN）可导致神经症状，如激惹、意识丧失和癫痫发作。在某些情况下，也有AFBN相关急性脑病的报道。本报告描述了首例AFBN合并急性脑病且脑部MRI无明显异常发现的病例。患者为一名3岁男性，在1岁和2岁时曾有两次热性惊厥发作。入院后第二天出现意识障碍、易怒、易激惹和颈部强直。脑部MRI未见异常；然而，脑电图（EEG）显示有广泛性高电压慢波。其尿沉渣计数升高，尿培养检测到摩根摩根菌和粪肠球菌。诊断为急性脑病合并尿路感染（UTI）。给予静脉（IV）抗生素治疗UTI，同时给予甲泼尼龙冲击疗法和静脉注射免疫球蛋白治疗急性脑病。此外，增强CT显示双肾均有AFBN。由于第8天脑电图上持续出现高电压慢波，患者接受了第二个疗程的甲泼尼龙冲击疗法。此外，增强CT显示双肾均有AFBN。最终诊断为AFBN合并急性脑病；然而，我们最初诊断为与UTI相关的热性惊厥。应注意急性脑病与AFBN有关。
