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[A case of clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) associated with

Ryoko Anada1, Takamasa Nukui1, Tomohiro Hayashi1

  • 1Department of Neurology, Toyama University Hospital.

Rinsho Shinkeigaku = Clinical Neurology
|October 1, 2019
PubMed

Insights

This case report highlights a rare instance of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) linked to Staphylococcus aureus infectious endocarditis in a young woman. The brain MRI lesions resolved, underscoring the reversible nature of MERS.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Cardiology

Background:

  • Infectious endocarditis is a serious condition often requiring prompt diagnosis and treatment.
  • Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a distinct clinicoradiological entity characterized by reversible splenial lesions on MRI.
  • The association between MERS and infectious endocarditis is not well-established.

Observation:

  • A 17-year-old female presented with fever, altered consciousness, and delirium, found to have Methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia.
  • Initial transthoracic echocardiogram was normal, but a subsequent MRI revealed a reversible splenial lesion.
  • Development of a systolic murmur led to a diagnosis of infectious endocarditis, with resolution of neurological symptoms and MRI findings.

Findings:

  • This case demonstrates MERS occurring in the context of Staphylococcus aureus infectious endocarditis.
  • The splenial lesion on diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps showed characteristic changes.
  • Complete resolution of the splenial lesion was observed after treatment, correlating with clinical improvement.

Implications:

  • This case expands the known spectrum of conditions associated with MERS, suggesting infectious endocarditis as a potential trigger.
  • Clinicians should consider MERS in patients with neurological symptoms and evidence of endocarditis, particularly when Staphylococcus aureus is implicated.
  • Further research is warranted to elucidate the pathophysiology and incidence of MERS in infectious endocarditis.
Keywords:
MERSStaphylococcus aureusinfectious endocarditissplenial lesion

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