[Acute urinary retention secondary to aseptic meningoencephalitis in an infant--case report].
We report the case of a 21-month-old boy with urinary retention secondary to aseptic meningitis. After high fever for 10 days, appetite loss, somnolence, acute transient urinary retention, constipation and mild dysesthesia in bilateral lower limbs developed. Brisk reflexes were present in the lower extremities along with a positive Babinski reflex. Cerebrospinal fluid (CSF) examination revealed mild mononuclear cell-dominant pleocytosis. Human herpes virus (HHV)-6 was not detected in the CSF by polymerase chain reaction (PCR) analysis; however, it was detected in the throat, plasma, and mononuclear cells of the peripheral blood. Virus-specific immunoglobulin M antibodies against HHV-6 were not detected by enzyme immunoassay. Brain magnetic resonance imaging (MRI) yielded normal results; however, T1-weighted MRI of the conus terminalis with contrast enhancement showed region of high intensity from the lower thoracic to lumbar meninges. In T2-weighted imaging, slight hyperintensity was observed in the lumbar spinal cord without enhancement effect. The catheter was removed 1 week after high-dose intravenous methyl-prednisolone treatment and the patient was able to walk 3 weeks later without any sequelae. Vesicorectal disturbance and the neurological symptoms observed in aseptic meningitis were similar to those of HSV type 2-induced lumbosacral meningo-radiculitis, designated as Elsberg syndrome or meningitis-retention syndrome in adults. The recurrence of HHV-6 might be immunologically related to this meningitis-retention syndrome based on the results of PCR analysis and enzyme immunoassay for virus-specific antibodies. Several reports have described lumbosacral meningo-radiculitis in adults and older children, but this appears to be particularly rare in infants.
Department of Pediatrics, Tokyo Metropolitan Komagome Hospital, Bunkyo-ku, Tokyo 113 8677, Japan.
Machiko
M
Kawamura
Hidefumi
H
Kaku
Naohide
N
Takayama
Takashi
T
Ushimi
Shuji
S
Kishida
D000208:Acute Disease; D015654:Herpesvirus 6, Human; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008582:Meningitis, Aseptic / Q000150:complications*; D008590:Meningoencephalitis / Q000145:classification*; D019349:Roseolovirus Infections / Q000150:complications; D016055:Urinary Retention / Q000209:etiology*