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Published on: April 28, 2019
Diphtheric encephalitis and brain neuroimaging features
Jen Chun Foo1, Kartini Rahmat2, Nazimah Ab Mumin3
1Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Insights
This case study details a rare paediatric diphtheria infection complicated by encephalitis in an unvaccinated child. Early neuroimaging is crucial for diagnosing diphtheric encephalitis, especially when cerebrospinal fluid analysis is inconclusive.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Diphtheria, a vaccine-preventable disease, can lead to severe neurological complications.
- Encephalitis is a rare but serious manifestation of diphtheria, particularly in unvaccinated children.
Observation:
- A 6-year-old unvaccinated boy presented with seizures, fever, and exudative tonsillitis with pseudomembrane, indicative of diphtheria.
- The patient developed progressive encephalopathy and focal neurological deficits, requiring mechanical ventilation.
- Throat swab PCR confirmed diphtheria toxin A and B, and the patient received diphtheria antitoxin.
Findings:
- Brain MRI revealed T2-weighted hyperintensities in the anterior cingulate gyri, insular cortex, and cerebellum.
- These findings represent the first reported MRI characteristics of diphtheric encephalitis.
- Cerebrospinal fluid findings were unremarkable, underscoring the diagnostic utility of MRI.
Implications:
- This case highlights the importance of timely diphtheria vaccination.
- Neuroimaging, particularly MRI, is essential for diagnosing diphtheric encephalitis, especially in atypical presentations.
- The findings contribute to understanding the neuroinvasive potential of diphtheria and guiding clinical management.
Abstract:
We report a rare case of paediatric diphtheria complicated with encephalitis. A 6-year-old boy who did not receive his scheduled diptheria-tetanus-pertusis vaccination presented with one episode of generalised convulsive seizure. His illness was preceded by a 3day history of fever associated with enlarged exudative tonsils with a pseudomembrane. He was commenced on intravenous penicillin and oral erythromycin. However, he developed progressive encephalopathy with focal neurological deficit which required intubation on day 5 of illness. Throat swab polymerase chain reaction for diphtheria toxin A and B were positive and diphtheria antitoxin was given. Magnetic resonance imaging (MRI) of brain showed T2-weighted hyperintensities over the anterior cingulate gyri, insular cortex and cerebellum. This is the first reported MRI finding of diphtheric encephalitis. Our report highlights the importance of neuroimaging in diagnosing diphtheric encephalitis particularly in cases with unremarkable cerebrospinal findings.
