1. Chronic meningitis with intracranial hypertension and bilateral neuroretinitis following Mycoplasma pneumoniae infection.
- Author
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Karampatsas K, Patel H, Basheer SN, and Prendergast AJ
- Subjects
- Abducens Nerve Diseases diagnosis, Abducens Nerve Diseases etiology, Child, Headache cerebrospinal fluid, Headache diagnosis, Headache etiology, Headache microbiology, Humans, Inflammation diagnosis, Inflammation etiology, Intracranial Hypertension cerebrospinal fluid, Intracranial Hypertension diagnosis, Male, Meningitis cerebrospinal fluid, Meningitis diagnosis, Meningitis drug therapy, Meningitis etiology, Meningitis, Aseptic cerebrospinal fluid, Meningitis, Aseptic diagnosis, Meningitis, Aseptic drug therapy, Mycoplasma Infections cerebrospinal fluid, Mycoplasma Infections immunology, Mycoplasma Infections microbiology, Papilledema diagnosis, Papilledema etiology, Retinitis diagnosis, Vision Disorders diagnosis, Vision Disorders etiology, Intracranial Hypertension etiology, Meningitis, Aseptic etiology, Mycoplasma Infections complications, Mycoplasma pneumoniae, Retina pathology, Retinitis etiology
- Abstract
A previously well 12-year-old boy presented with a 2-week history of headache, nausea, vomiting and left-sided weakness. He subsequently developed meningism, right abducens nerve palsy, persistent papilloedema and reduced visual acuity in association with a bilateral macular star, consistent with neuroretinitis. Cerebrospinal fluid (CSF) examination indicated chronic meningitis and serological testing confirmed recent Mycoplasma pneumoniae infection, although PCR in CSF was negative. He was treated for aseptic meningitis with ceftriaxone, aciclovir, azithromycin and acetazolamide for intracranial hypertension, with gradual improvement in clinical condition and visual acuity over several weeks. This is the first report of M. pneumoniae chronic meningitis further complicated with bilateral neuroretinitis and intracranial hypertension. Evidence of central nervous system inflammation in the absence of direct infection suggests an immune-mediated pathophysiology. Although the use of macrolides with antibiotic and immunomodulatory activity might be beneficial, it was not possible to ascertain whether it influenced clinical recovery in this case., (2014 BMJ Publishing Group Ltd.)
- Published
- 2014
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