[Encephalopathy in an adult with Shigella]

A case of sporadic shigellosis is reported. A 30 year old woman, presented neurologic dysfunction, mild watery diarrhea and fever which had started one week before her admission. Abdominal tenderness, confusion, delirium, impairment of orientation and of recent memory were found. Abnormal motor activity with rigidity, tremors, myoclonus around the mouth also existed. There were neither focal signs nor signs of meningeal irritation. Computed tomography and nuclear magnetic resonance of the brain were normal. Laboratory analyses did not explain the anomalies. Several deep ulcers were disclosed by colonoscopy and a S. flexneri was isolated from the material extracted by endoscopy. Nonspecific colitis was informed by pathology. The patient was treated with 400 mg ciprofloxacin for 14 days, with improvement of the clinical picture. The most prominent aspect in this case was the clinical presentation with predominant neurologic symptoms creating the impression of a primary nervous system disease. Admission diagnosis was viral encephalitis. We believe that all of the anomalies present in our patient, the diarrhea and encephalopathy, were produced by the same etiologic agent, S. flexneri and by its toxins.