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A Murine Model of Dengue Virus-induced Acute Viral Encephalitis-like Disease
Published on: April 28, 2019
Rhinovirus-associated acute encephalitis/encephalopathy and cerebellitis
Kyoko Hazama1, Takashi Shiihara1, Hiroyuki Tsukagoshi2
1Department of Neurology, Gunma Children's Medical Center, 779 Shimohakoda, Hokkitsu-machi, Shibukawa, Gunma 377-8577, Japan.
Insights
Human rhinovirus A caused acute cerebellitis and encephalitis in a child, a rare central nervous system complication. This case highlights the need for broader pathogen detection in pediatric neurological illness.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Rhinovirus is a common pediatric respiratory pathogen.
- Central nervous system (CNS) involvement by rhinovirus is exceptionally rare, with only two prior cases (meningitis, sepsis-like illness).
Observation:
- A 2-year-old boy presented with fever, seizures, and lethargy.
- Cerebrospinal fluid analysis revealed mild pleocytosis and elevated protein.
- Brain MRI demonstrated bilateral cerebellar dentate nucleus abnormalities, particularly on diffusion-weighted imaging.
Findings:
- Human rhinovirus A was identified in both throat swab and cerebrospinal fluid specimens.
- The patient developed acute cerebellitis with concurrent cerebral symptoms (consciousness disturbance, seizures).
- Cerebellar atrophy was noted on follow-up MRI despite symptomatic treatment and recovery.
Implications:
- This case represents the first reported instance of rhinovirus-associated acute encephalitis/encephalopathy with concurrent cerebellitis.
- It underscores the importance of considering rhinovirus in the differential diagnosis of pediatric acute neurological conditions.
- Further research utilizing advanced molecular techniques is crucial to understand the pathophysiology of rhinovirus-induced CNS disease.
Background:
Rhinovirus is a common respiratory pathogen for children throughout the year; nevertheless, its central nervous system involvement is extremely rare, and only two cases have been reported to date: meningitis and sepsis-like illness.
Patient:
A previously healthy 2-year-old Japanese boy developed fever, followed by seizures and lethargy. His cerebrospinal fluid cell count and protein level were slightly increased; brain magnetic resonance imaging showed abnormal intensities in the bilateral cerebellar dentate nuclei, which were prominent in diffusion-weighted images. After his consciousness disturbance improved, cerebellar dysfunction became apparent. He was treated symptomatically, without steroids or any other immunosuppressants. He almost recovered within a few months; however, cerebellar atrophy became evident on brain magnetic resonance imaging. Using acute specimens, human rhinovirus A was detected in his throat swab and cerebrospinal fluid.
Discussion:
Acute cerebellitis, in which cerebellar inflammation is predominant, is occasionally accompanied by cerebral symptoms, such as consciousness disturbance and seizures. As a causative pathogen, rotavirus is the most common; however, rhinovirus-associated acute encephalitis/encephalopathy and concurrent cerebellitis have not been reported before. Further research, using recent molecular techniques to detect various central nervous system pathogens, including rhinovirus, is needed to delineate the underlying pathophysiology.
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