Hafez Wael, Hassan Surra, Sinha Shobhit, Elbaghdady Mohamed Tawfik, Alhanafy Marwa Mohamed Ali, Mohammed Wafa, ElshekhAli Hossam, Krishnareddy Kalpana
Internal Medicine Department; NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates.
Internal Medicine Department; Medical Research and Clinical Studies Institute, The National Research Centre, Cairo, Egypt.
Radiol Case Rep. 2025 Jun 10;20(9):4266-4270. doi: 10.1016/j.radcr.2025.05.032. eCollection 2025 Sep.
A 26-year-old male patient with no significant medical history presented with a 2-weeks history of fever, dry cough, and progressive dyspnea. Neurological examination showed bilateral extensor plantar responses, suggesting a possible involvement of upper motor neurons and significant cerebellar dysfunction, including wide-based gait, positive dysmetria, and ataxia. Laboratory results confirmed Mycoplasma pneumoniae infection, while initial chest radiography suggested atypical pneumonia. Brain MRI showed no structural lesions, supporting the diagnosis of a functional or inflammatory cause rather than a primary structural abnormality. CSF Gram staining and culture returned negative results; however, CSF analysis showed elevated total WBCs with lymphocytic pleocytosis. These results, together with rapidly progressive neurological symptoms, support the diagnosis of inflammatory immune-mediated meningoencephalitis rather than direct bacterial or viral infection. After starting oral azithromycin, the patient's respiratory symptoms showed some improvement. However, the patient had severe gait imbalance to the extent that he was unable to walk on their own and in need for support from both sides. After a 5 days course of intravenous immunoglobulin (IVIG) and azithromycin was completed within 7 days, the patient started to improve with great recovery at the end of therapy. On follow-up in the outpatient clinic, patients with nearly complete recovery within a few weeks of discharge.
一名26岁男性患者，既往无重大病史，出现发热、干咳和进行性呼吸困难2周。神经系统检查显示双侧跖伸反应，提示可能存在上运动神经元受累以及明显的小脑功能障碍，包括宽基步态、辨距不良阳性和共济失调。实验室检查结果证实为肺炎支原体感染，而初始胸部X线检查提示非典型肺炎。脑部MRI未显示结构病变，支持功能性或炎症性病因的诊断，而非原发性结构异常。脑脊液革兰氏染色和培养结果为阴性；然而，脑脊液分析显示总白细胞升高，淋巴细胞增多。这些结果，连同快速进展的神经系统症状，支持炎症免疫介导的脑膜脑炎的诊断，而非直接的细菌或病毒感染。开始口服阿奇霉素后，患者的呼吸道症状有所改善。然而，患者存在严重的步态失衡，以至于无法独自行走，需要双侧支撑。在7天内完成5天疗程的静脉注射免疫球蛋白（IVIG）和阿奇霉素治疗后，患者开始好转，治疗结束时恢复良好。在门诊随访时，患者出院后几周内几乎完全康复。
