Comparison of mild encephalopathy with reversible splenial lesion with and without acute focal bacterial nephritis
Yuta Maruyama1, Masanori Sato2, Yuji Inaba3
1Department of Pediatric Intensive Care, Nagano Children's Hospital, Azumino, Japan; Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan.
Objective:
Clinically mild encephalitis/encephalopathy with a reversible lesion (MERS) is characterized by reversible lesions with transiently-reduced diffusion in the splenium of the corpus callosum on magnetic resonance imaging. Recently, cases of MERS with accompanying acute focal bacterial nephritis (AFBN) have been reported in children. This study aimed to clarify the clinical features of MERS with AFBN.
Methods:
A retrospective study of patients with MERS was conducted at Nagano Children's Hospital, Japan, from April 2013 to March 2018. The clinical signs and laboratory findings of MERS patients with AFBN (AFBN group) and without AFBN (non-AFBN group) were measured and compared.
Results:
Of 12 patients diagnosed as having MERS, 3 were also found to have AFBN. Seven of the 9 patients without AFBN were associated with infectious agents, including rotavirus and influenza viruses. No patient received steroids or intravenous immunoglobulin therapy, and none displayed neurological sequelae. Serum C-reactive protein (CRP) levels were significantly higher in the AFBN group than in the non-AFBN group (14.7 mg/dL versus 0.8 mg/dL, P = 0.009). AFBN group patients were also significantly older (97 months versus 27 months, P = 0.018) and experienced significantly less frequent seizures (33% versus 100%, P = 0.045). The mean duration of neurological symptoms was significantly longer in the AFBN group than in the non-AFBN group (4 days versus 1.7 days, P = 0.013).
Conclusions:
Pediatric patients with AFBN often present with non-specific findings, such as fever and abdominal pain. Pediatricians should be aware of the possibility of AFBN in the clinical setting of MERS, particularly when the patient exhibits inexplicably high CRP.
Insights
Mild encephalitis/encephalopathy with a reversible lesion (MERS) in children can co-occur with acute focal bacterial nephritis (AFBN). Pediatricians should consider AFBN in MERS cases with high CRP levels, as it presents with non-specific symptoms.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Nephrology
Background:
- Mild encephalitis/encephalopathy with a reversible lesion (MERS) is defined by reversible MRI lesions.
- Recent reports indicate MERS can be accompanied by acute focal bacterial nephritis (AFBN) in children.
- The clinical characteristics of MERS with AFBN require further elucidation.
Purpose of the Study:
- To clarify the clinical features of pediatric MERS patients with co-occurring AFBN.
- To compare clinical and laboratory findings between MERS patients with and without AFBN.
Main Methods:
- A retrospective study was conducted at Nagano Children's Hospital.
- MERS patients were categorized into AFBN and non-AFBN groups.
- Clinical signs and laboratory data were analyzed and compared between groups.
Main Results:
- Three of 12 MERS patients had concurrent AFBN.
- The AFBN group was older, had higher CRP levels, and experienced fewer seizures than the non-AFBN group.
- Neurological symptoms lasted longer in the AFBN group.
Conclusions:
- Pediatric AFBN in MERS cases often presents with non-specific symptoms like fever and abdominal pain.
- High serum CRP levels in MERS patients may indicate co-existing AFBN.
- Increased awareness of AFBN is crucial for pediatricians managing MERS.
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