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Published on: February 24, 2023
Clinically mild encephalitis/encephalopathy with a reversible splenial lesion associated with Mycoplasma pneumoniae
Zhe-Feng Yuan1, Jue Shen2, Shan-Shan Mao1
1Department of neurology, The Children's Hospital of Zhejiang University School of Medicine, 57 Zhugan Xiang, Hangzhou, 310003, Zhejiang Province, China.
Background:
Clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a clinico-radiological syndrome characterized by transient mild symptoms of encephalopathy and a reversible lesion in the splenium of the corpus callosum on magnetic resonance imaging (MRI). It is often triggered by infection. The common pathogens of MERS are viruses, especially influenza virus. However, Mycoplasma pneumoniae (M.pneumoniae) are relatively rare pathogens for MERS.
Case Presentation:
Here we report two paediatric cases of M.pneumoniae infection-induced MERS. The diagnosis of M.pneumoniae infection was established based on polymerase chain reaction (PCR) and specific serum antibodies (IgM). Both of the two patients presented with mild encephalopathy manifestations and recovered completely within a few days. The initial MRI showed a lesion in the central portion of the splenium of the corpus callosum, which completely resolved on the seventh and eighth day after admission for case 1 and case 2. Lumbar puncture was performed in both patients, which revealed no pleocytosis. In case 1, the patient had hyponatremia, peripheral facial nerve paralysis, and rash. To the best of our knowledge, it is the first MERS case associated with peripheral nerve damage. In case 2, interleukin-6(IL-6) was moderately increased in the cerebrospinal fluid (CSF). It suggested that IL-6 may play a role in the pathogenesis of M.pneumoniae-induced MERS.
Conclusion:
Our study enriches the available information on the pathogens of MERS and provides valuable data for better understanding of this syndrome.
Insights
Mycoplasma pneumoniae infections can cause mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). This study presents two pediatric cases, highlighting rare associations like peripheral nerve damage and potential IL-6 involvement in MERS pathogenesis.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a syndrome of transient encephalopathy and reversible corpus callosum lesions.
- MERS is typically triggered by viral infections, with influenza being common.
- Mycoplasma pneumoniae is a rare but recognized cause of MERS.
Observation:
- Two pediatric cases of MERS caused by Mycoplasma pneumoniae infection are presented.
- Patients exhibited mild encephalopathy and complete recovery.
- MRI revealed reversible splenial lesions, and CSF showed no pleocytosis.
Findings:
- Mycoplasma pneumoniae infection confirmed by PCR and IgM antibodies.
- One case presented with hyponatremia, facial nerve paralysis, and rash, suggesting peripheral nerve involvement.
- Elevated cerebrospinal fluid IL-6 levels in one case indicate a potential role in MERS pathogenesis.
Implications:
- This study expands the known spectrum of MERS pathogens.
- It provides insights into the clinical presentation and potential mechanisms of M. pneumoniae-induced MERS.
- Findings contribute to a better understanding of MERS and its management.
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