J Korean Child Neurol Soc.  2018 Mar;26(1):70-73. 10.26815/jkcns.2018.26.1.70.

A Case of Acute Hemorrhagic Encephalomyelitis associated with Mycoplasma Pneumoniae Infection

• Choi Y
• Lee J
• Suh ES

• KMID: 2435279
• DOI: http://doi.org/10.26815/jkcns.2018.26.1.70

Abstract

Acute hemorrhagic encephalomyelitis (AHEM) is a severe form of encephalitis characterized by fulminant clinical course and presence of hemorrhagic necrosis of the white matter. Mycoplasma pneumoniae (M. pneumoniae) have severe central nervous syndrome complication with encephalitis as that most common pediatric manifestations, but have been extremely rare report with AHME. A 10-year-old boy was referred to emergency room because of drowsy mental status, weakness of left side extremities and truncal ataxia. His deep tendon reflexes were hyperactive, neck stiffness sign and Babinski sign were both positive. Motor power were decreased on the both left upper and lower extremities. The sequences of T2-weighted and gradient recalled echo (GRE) showed hyper-intense lesions on multifocal white natter areas with hemorrhagic signal. Cerebrospinal fluid (CSF) analysis showed the pleocytosis with neutrophil dominant. The results of deoxyribonucleic acid (DNA) test and culture of M. pneumoniae were reported negative in CSF, but immunoglobulin M (IgM) was positive in blood. He received intravenous high dose corticosteroid and macrolide. After discharge, his neurologic function gradually returned to normal including sitting and standing without support. We reported the previously healthy boy with M. pneumonia related AHEM. The early diagnosis with brain MRI and the aggressive immunosuppressive treatment may be beneficial for recovery.

Keyword

Acute hemorrhagic encephalomyelitis (AHEM); Mycoplasma pneumoniae

MeSH Terms

Ataxia
Brain
Cerebrospinal Fluid
Child
DNA
Early Diagnosis
Emergency Service, Hospital
Encephalitis
Extremities
Humans
Immunoglobulin M
Leukocytosis
Leukoencephalitis, Acute Hemorrhagic*
Lower Extremity
Magnetic Resonance Imaging
Male
Mycoplasma pneumoniae*
Mycoplasma*
Neck
Necrosis
Neutrophils
Pneumonia
Pneumonia, Mycoplasma*
Reflex, Babinski
Reflex, Stretch
White Matter
DNA
Immunoglobulin M