Ikenouchi Hajime, Suzuki Keisuke, Sato Ayumi, Yamamoto Naoki, Miyamoto Tatsuo, Endo Kaoru
Division of Neurology, Sendai City Hospital, 1-1-1 Asuto-Nagamachi, Taihaku-ku, Sendai, 982-8502, Japan.
Division of Cardiology, Sendai City Hospital, 1-1-1 Asuto-Nagamachi, Taihaku-ku, Sendai, 982-8502, Japan.
J Infect Chemother. 2024 Mar;30(3):263-265. doi: 10.1016/j.jiac.2023.10.013. Epub 2023 Oct 19.
A 37-year-old woman was hospitalized with fever and consciousness disturbance. She showed systemic inflammation with stress cardiomyopathy. Brain computed tomography showed diffuse brain edema. Cerebrospinal fluid (CSF) findings revealed markedly elevated cerebrospinal fluid pressure with pleocytosis, elevated protein, and elevated interleukin 6. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nicking enzyme amplification reaction test using a nasopharyngeal swab was positive, and the patient was diagnosed with SARS-CoV-2 infection. From the negative result of the CSF SARS-CoV-2 polymerase chain reaction test and no findings of bacterial or viral infection, we diagnosed meningoencephalitis by multisystem inflammation syndrome in adults (MIS-A). Intravenous methylprednisolone pulse therapy improved her symptoms and brain edema. There have been no cases of MIS-A with meningoencephalitis, and no initial treatment strategy has been established, especially in emergency cases of suspected MIS-A. The present case suggested Early intravenous methylprednisolone pulse with anti-coronaviral therapies after the exclusion of bacterial infection would be useful in suspected MIS-A with emergent meningoencephalitis cases.
一名37岁女性因发热和意识障碍入院。她表现出全身性炎症并伴有应激性心肌病。脑部计算机断层扫描显示弥漫性脑水肿。脑脊液检查结果显示脑脊液压力显著升高，伴有细胞增多、蛋白升高和白细胞介素6升高。使用鼻咽拭子进行的严重急性呼吸综合征冠状病毒2（SARS-CoV-2）切口酶扩增反应检测呈阳性，该患者被诊断为SARS-CoV-2感染。由于脑脊液SARS-CoV-2聚合酶链反应检测结果为阴性且未发现细菌或病毒感染，我们诊断该患者为成人多系统炎症综合征（MIS-A）所致的脑膜脑炎。静脉注射甲泼尼龙冲击疗法改善了她的症状和脑水肿。此前尚无MIS-A合并脑膜脑炎的病例，也未确立初始治疗策略，尤其是在疑似MIS-A的紧急病例中。本病例提示，在排除细菌感染后早期静脉注射甲泼尼龙冲击并联合抗病毒治疗，对于疑似MIS-A合并急性脑膜脑炎的病例可能有用。
