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High-dose steroid and heparin: a novel therapy for cerebral vasculitis associated with presumed group A Streptococcus

Brian Alexander Hummel1, Julie Blackburn2, Anne Pham-Huy3

  • 1Division of Infectious Diseases, Immunology and Allergy, Department of Pediatrics, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada bhummel@cheo.on.ca.

BMJ Case Reports
|February 10, 2021
PubMed

Cerebral vasculitis is a serious complication of bacterial meningitis that can cause significant morbidity and mortality due to stroke. Currently, there are no treatment guidelines or safety and efficacy studies on the management of cerebral vasculitis in this context. Herein, we report a case of a previously well 11-year-old girl who presented with acute otitis media that progressed to mastoiditis and fulminant meningitis. Group A Streptococcus was found in blood and ear-fluid cultures (lumbar puncture was unsuccessful). Her decreased level of consciousness persisted despite appropriate antimicrobial treatment, and repeat MRI revealed extensive large vessel cerebral vasculitis. Based on expert opinion and a presumed inflammatory mechanism, her cerebral vasculitis was treated with 7 days of pulse intravenous methylprednisolone followed by oral prednisone taper. She was also treated with intravenous heparin. Following these therapies, she improved clinically and radiographically with no adverse events. She continues to undergo rehabilitation with improvement.

Keywords:
infection (neurology)meningitisneurology (drugs and medicines)stroke

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