Bilateral Optic Neuritis Caused by Meningococcal Meningoencephalitis

Herta Zellner; Andreas Entenmann; Iris Unterberger; Armin Muigg; Stephan Egger; Miriam Kössler; Fiona Zeiner; Matthias Baumann; Barbara Teuchner; Tanja Janjic; Diana Putz; Manuela Zlamy

doi:10.1055/s-0041-1741071

Journal of Pediatric Neurology, Table of Contents

Journal of Pediatric Neurology 2022; 20(02): 148-151
DOI: 10.1055/s-0041-1741071

Case Report

Bilateral Optic Neuritis Caused by Meningococcal Meningoencephalitis

Herta Zellner

¹Department of Pediatrics, Innsbruck Medical University, Innsbruck, Austria

,

Andreas Entenmann

¹Department of Pediatrics, Innsbruck Medical University, Innsbruck, Austria

,

Iris Unterberger

²Department of Neurology, Innsbruck Medical University, Innsbruck, Austria

,

Armin Muigg

²Department of Neurology, Innsbruck Medical University, Innsbruck, Austria

,

Stephan Egger

³Department of Pediatrics, Bruneck Hospital, Italy

,

Miriam Kössler

¹Department of Pediatrics, Innsbruck Medical University, Innsbruck, Austria

,

Fiona Zeiner

¹Department of Pediatrics, Innsbruck Medical University, Innsbruck, Austria

,

Matthias Baumann

¹Department of Pediatrics, Innsbruck Medical University, Innsbruck, Austria

,

Barbara Teuchner

⁴Department of Ophthalmology, Innsbruck Medical University, Innsbruck, Austria

,

Tanja Janjic

⁵Department of Neuroradiology, Innsbruck Medical University, Innsbruck, Austria

,

Diana Putz

⁴Department of Ophthalmology, Innsbruck Medical University, Innsbruck, Austria

,

Manuela Zlamy

¹Department of Pediatrics, Innsbruck Medical University, Innsbruck, Austria

› Author Affiliations

Abstract

In this article, we described a case of pathogen-induced bilateral optic neuritis accompanying meningococcal meningoencephalitis in an adolescent male. A 15-year-old boy presented to our emergency room due to progressive severe headache, stiff neck, diffuse extremity pain, fever, and nausea concerning meningoencephalitis. Intravenous ceftriaxone, metamizole, and ondansetron were started immediately. Due to acute autonomic dysregulation and development of petechiae, he was transferred to the pediatric intensive care unit. Next morning, the patient developed severe visual impairment. Investigations revealed elevated C-reactive protein, procalcitonin and leucocyte count, decreased platelet count, and clotting activation. Cerebrospinal fluid (CSF) analysis revealed increased leucocyte count, protein, and decreased glucose concentration with pathological CSF cytology. Brain magnetic resonance imaging revealed an increased contrast enhancement in the optic nerve sheath, consistent with acute bilateral optic neuritis. He was started on high-dose intravenous pulse methylprednisolone therapy. After treatment with ceftriaxone und pulse steroids, the patient was discharged in good condition without any visual sequel.

Keywords

meningococci - optic neuritis - meningoencephalitis

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References

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