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Journal of Pediatric Neurology
DOI: 10.1055/s-0043-1778101
Original Article

Mycoplasma pneumoniae-Associated Encephalitis: Favorable Aggressive Immunosuppression in a Patient

Elvio Della Giustina 
1   Pathologic Anatomy Section, Maternal-Pediatric and Adult Department of Clinical and Surgical Sciences, University of Modena and Reggio Emilia (UNIMORE), Modena, Italy
,
Patrizia Bergonzini
2   Pediatric Unit, Maternal-Pediatric and Adult Department of Clinical and Surgical Sciences, University of Modena and Reggio Emilia (UNIMORE), Modena, Italy
,
Michele Sintini
3   Radiologic Unit, State Hospital, Republic of San Marino
,
Carlotta Spagnoli
4   Struttura Complessa di Neuropsichiatria Infantile, AUSL, IRCCS di Reggio Emilia, Reggio Emilia, Italy
,
Carlo Fusco
4   Struttura Complessa di Neuropsichiatria Infantile, AUSL, IRCCS di Reggio Emilia, Reggio Emilia, Italy
,
Tiziana Salviato
1   Pathologic Anatomy Section, Maternal-Pediatric and Adult Department of Clinical and Surgical Sciences, University of Modena and Reggio Emilia (UNIMORE), Modena, Italy
,
Luca Reggiani Bonetti
1   Pathologic Anatomy Section, Maternal-Pediatric and Adult Department of Clinical and Surgical Sciences, University of Modena and Reggio Emilia (UNIMORE), Modena, Italy
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Abstract

Meningoencephalitis is the most important extrapulmonary manifestation of Mycoplasma pneumoniae infection. It is complicated by seizures in at least 40% of cases, and in half of them, status epilepticus can occur during the acute phase, often leading to severe neurological sequelae. Brain imaging ranges from normal to diffuse edema, focal changes, and abnormal signals in the white matter, basal ganglia, and hippocampi. Here, we describe a boy who presented with an acute onset of transient alteration of behavior, meningeal irritation, fever, vomiting, and leg pain. Meningoencephalitis due to M. pneumoniae infection was confirmed by focal pneumonia, positive immunological tests, and increased protein content in cerebrospinal fluid. Magnetic resonance imaging of the brain showed bilateral focal abnormalities in the temporoinsular cortex, and electroencephalographic recordings showed slow waves in the same regions. After early infusion of acyclovir on the first day, aggressive combination therapy with oral erythromycin, and intravenous methylprednisolone and immunoglobulin was promptly initiated once a complete diagnosis was obtained on the second day, and the boy recovered within a few days. Two weeks later, brain imaging findings had resolved completely. The rapid clinical and neuroradiological recovery after immunosuppressive therapy suggests an immune-mediated pathogenetic mechanism. He developed immune-mediated myositis 2 years later demonstrating the instability of his immunological status.

Keywords

encephalitis - immunosuppression - MRI - Mycoplasma pneumoniae

Authors' Contributions

Conceptualization was done by E.D.G., P.B., C.S., and C.F.; data curation by E.D.G., P.B., M.S., C.F., and L.R.B.; writing—original draft preparation by E.D.G.; and writing—review and editing by E.D.G., M.S., C.S., and T.S. All authors have read and agreed to the published version of the manuscript.




Publication History

Received: 05 May 2023

Accepted: 04 December 2023

Article published online:
19 February 2024

© 2024. Thieme. All rights reserved.

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