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Pediatric diabetic ketoacidosis presenting with Streptococcus intermedius brain abscess

Judy L Mintz1, Morghan B Jameson1, Leah Akinseye2

  • 1East Tennessee State University James H Quillen College of Medicine, Johnson City, Tennessee, USA.

Journal of Pediatric Endocrinology & Metabolism : JPEM
|April 14, 2021
PubMed

Insights

A pediatric case reveals new-onset type 1 diabetes with diabetic ketoacidosis (DKA) and a concurrent Streptococcus intermedius brain abscess. This highlights the importance of considering co-occurring conditions in DKA patients with neurological symptoms.

Area of Science:

  • Pediatric Endocrinology
  • Neurology
  • Infectious Diseases

Background:

  • Type 1 diabetes (T1D) diagnosis in children often presents with diabetic ketoacidosis (DKA).
  • Brain abscesses are serious intracranial infections requiring prompt diagnosis and treatment.
  • Streptococcus intermedius is a known pathogen capable of causing brain abscesses.

Observation:

  • A previously healthy 12-year-old girl presented with new-onset T1D and mild DKA.
  • During hospitalization, she developed seizures and was diagnosed with a right frontal parasagittal brain abscess caused by S. intermedius.
  • Neurological symptoms emerged as DKA resolved with insulin therapy, suggesting a link between ketosis and epilepsy management.

Findings:

  • The case demonstrates a rare co-occurrence of new-onset T1D with DKA and S. intermedius brain abscess in a pediatric patient.
  • Resolution of ketosis with insulin treatment unmasked neurological symptoms, supporting the role of therapeutic ketosis in managing refractory epilepsy.
  • S. intermedius was identified as the causative agent of the brain abscess.

Implications:

  • This case underscores the necessity of evaluating for comorbid conditions in pediatric patients presenting with DKA and new neurological symptoms.
  • It highlights the potential connection between therapeutic ketosis and the management of medication-refractory epilepsy.
  • Clinicians should maintain a high index of suspicion for serious infections like brain abscesses in diabetic ketoacidosis patients with atypical neurological presentations.
Abstract

Keywords:
DKAStreptococcus intermediusbrain abscess

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