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Streptococcus pneumoniae meningoencephalitis with unusual and widespread white matter lesions

Philippe G Jorens1, Paul M Parizel, Marek Wojciechowski

  • 1Department of Paediatric Critical Care Medicine, Antwerp University Hospital, UZA, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium. Philippe.Jorens@uza.be

European Journal of Paediatric Neurology : EJPN : Official Journal of the European Paediatric Neurology Society
|September 21, 2007
PubMed

Insights

This case report details a 7-month-old with severe brain inflammation from Streptococcus pneumoniae. Early MRI revealed unique, widespread white matter damage and sinus thrombosis, despite prompt treatment.

Area of Science:

  • Neurology
  • Pediatrics
  • Infectious Diseases

Background:

  • Streptococcus pneumoniae is a leading cause of bacterial meningitis with high mortality and neurological sequelae.
  • Pediatric meningitis requires prompt diagnosis and treatment to mitigate severe outcomes.

Observation:

  • An exceptional case of a 7-month-old infant presenting with meningoencephalitis caused by Streptococcus pneumoniae.
  • Magnetic resonance imaging (MRI) demonstrated peculiar, widespread signal abnormalities, including extensive central nervous system white matter injury.
  • Evidence of lateral transverse sinus thrombosis was also noted early in the disease course.

Findings:

  • The observed MRI changes, including cytotoxic edema, vasculitis, and acute demyelination, were unique and widespread.
  • These extensive lesions developed very early in the illness, even with early initiation of antibiotic and glucocorticoid therapy.
  • Diffuse white matter lesions of this nature in early pediatric Streptococcus pneumoniae meningoencephalitis have not been previously documented.

Implications:

  • This case highlights a rare and severe presentation of Streptococcus pneumoniae meningoencephalitis in a pediatric patient.
  • The findings suggest that early and aggressive treatment may not always prevent extensive neurological damage in severe cases.
  • Further research is warranted to understand the pathogenesis and identify potential novel therapeutic targets for such severe presentations.

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