title: [Fulminating meningitis caused by Haemophilus influenzae with rapid progression of severe brain edema similar to acute encephalopathy].
abstract: We report a 4-year-old boy with fulminating meningitis caused by Haemophilus influenzae (Hib). He suddenly developed fever, vomiting and then somnolence. As bacterial meningitis was suspected, treatment with antibiotics was started at 12 hours after the onset. However, there was a rapid progression of severe brain edema and brain hernia, leading to clinical brain death. His clinical course and neuroradiological findings mimicked those in patients with acute encephalopathy, with cytokine profiles in cerebrospinal fluid demonstrating a marked increase of inflammatory cytokines. From a review of the literature, fulminating Hib meningitis may be classified into two disease types: DIC plus multiple organ failure and acute brain swelling types. The present case belongs to the latter type, in which cytokine storm seems to play an important pathogenic role.
authors.affiliation: Department of Pediatrics, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki. shiraken@hotmail.co.jp
authors.forename: Kentaro
authors.initials: K
authors.lastname: Shirai
authors.forename: Keisuke
authors.initials: K
authors.lastname: Nakajima
authors.forename: Akimitsu
authors.initials: A
authors.lastname: Watanabe
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kawano
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sakuma
authors.forename: Takamasa
authors.initials: T
authors.lastname: Yoshida
authors.forename: Rie
authors.initials: R
authors.lastname: Miyata
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Tanuma
authors.forename: Masaharu
authors.initials: M
authors.lastname: Hayashi
mesh_terms: D001929:Brain Edema / Q000209:etiology; D002675:Child, Preschool; D016207:Cytokines / Q000032:analysis; D018450:Disease Progression; D006193:Haemophilus influenzae; D006801:Humans; D008297:Male; D008583:Meningitis, Haemophilus / Q000175:diagnosis*
chemical_list: D016207:Cytokines