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Nephritis and cerebellar ataxia: rare presenting features of enteric fever
R C Parmar1, S B Bavdekar, R Houilgol
1Department of Paediatrics, Seth G. S. Medical College and K. E. M. Hospital, Parel, Mumbai - 400 012, India. rameshparmar@yahoo.com
Abstract:
Enteric fever is a common infectious disease of the tropical world, about 80% of these cases occur in Asian countries. Enteric fever presenting with isolated cerebellar ataxia or nephritis is rare. We report three cases of enteric fever that presented with these complications. Isolated cerebellar ataxia usually occurs in the second week, whereas in our cases it presented within first four days of fever. The common complications of enteric fever related to the urinary tract are cystitis, pyelitis, and pyelonephritis. Glomerulonephritis is uncommon. Most patients with enteric glomerulonephritis present with acute renal failure, hypertensive encephalopathy, or nephritic syndrome. In comparison, our case had milder manifestations. All three patients were treated with parenteral ceftriaxone and showed a prompt recovery.
Insights
Enteric fever, a tropical infectious disease, rarely presents with cerebellar ataxia or nephritis. This report details three such cases, highlighting early onset ataxia and milder nephritis, all responding well to ceftriaxone treatment.
Area of Science:
- Infectious Diseases
- Neurology
- Nephrology
Background:
- Enteric fever is a prevalent infectious disease in tropical regions, predominantly affecting Asian countries.
- Typical enteric fever complications involve the urinary tract, such as cystitis and pyelonephritis.
- Neurological and renal complications like cerebellar ataxia and glomerulonephritis are considered rare presentations.
Observation:
- This report describes three rare cases of enteric fever presenting with isolated cerebellar ataxia and nephritis.
- Cerebellar ataxia manifested within the first four days of fever, earlier than the typical second-week onset.
- The observed nephritis cases exhibited milder symptoms compared to the usual acute renal failure or nephritic syndrome.
Findings:
- Early-onset cerebellar ataxia is a potential, albeit rare, complication of enteric fever.
- Enteric fever can present with atypical, milder forms of glomerulonephritis.
- Parenteral ceftriaxone demonstrated efficacy in treating these complex enteric fever presentations.
Implications:
- Clinicians should consider enteric fever in the differential diagnosis for patients presenting with early-onset cerebellar ataxia or atypical nephritis.
- Prompt recognition and treatment with appropriate antibiotics like ceftriaxone can lead to favorable outcomes.
- Further research is warranted to understand the pathogenesis and incidence of these rare enteric fever complications.