Department of Neurology, The Second Xiangya Hospital, Central South University, 139# Renmin Road, Changsha, Hunan, 410011, China.
Clinical Medical Research Center for Stroke Prevention and Treatment of Hunan Province, Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China.
BMC Infect Dis. 2024 Oct 7;24(1):1109. doi: 10.1186/s12879-024-10040-9.
Acute necrotizing encephalopathy (ANE), a rare and severe brain disorder, is typically linked to prior infections. ANE predominantly affects children, with most reported cases attributed to viral infections. However, instances of bacterial-induced ANE are infrequent. Here, we present a case of adult-onset ANE associated with bacterial infection.
The patient exhibited a hyperinflammatory state following a urinary tract bacterial infection, with neurological function rapidly declining into a coma as the illness progressed. Gram culture of blood suggested Escherichia coli infection. A magnetic resonance imaging (MRI) scan of the brain showed symmetrical hyperintense lesions involving bilateral thalami and pons in T2-weighted and fluid-attenuated inversion recovery images. These lesions also presented with diffuse cerebral edema and diffusion restriction and subacute hemorrhage. Based on clinical symptoms and typical brain MRI, ANE was diagnosed, and the patient underwent immunotherapy.
This case underscores the occurrence of ANE triggered by bacterial infection, expanding our understanding of the pathogens associated with this condition. It suggests that ANE may be an immune-mediated disorder rather than solely an infectious disease.
急性坏死性脑病（ANE）是一种罕见且严重的脑部疾病，通常与先前的感染有关。ANE 主要影响儿童，大多数报道的病例归因于病毒感染。然而，细菌性 ANE 的情况较为罕见。在此，我们报告一例与细菌感染相关的成人发病 ANE。
患者在泌尿道细菌感染后表现出高炎症状态，随着病情的发展，神经功能迅速恶化至昏迷状态。血液革兰氏培养提示大肠埃希菌感染。脑部磁共振成像（MRI）扫描显示 T2 加权和液体衰减反转恢复图像中双侧丘脑和脑桥存在对称性高信号病变。这些病变还表现为弥漫性脑水肿和弥散受限以及亚急性出血。根据临床症状和典型的脑部 MRI，诊断为 ANE，患者接受了免疫治疗。
本病例强调了细菌感染引发的 ANE 的发生，扩展了我们对该疾病相关病原体的认识。这表明 ANE 可能是一种免疫介导的疾病，而不仅仅是传染病。
