title: Acute encephalopathy and tubulointerstitial nephritis associated with Yersinia pseudotuberculosis.
abstract: We report the case of a 28-month-old boy with encephalopathy and acute tubulointerstitial nephritis possibly associated with Yersinia pseudotuberculosis (Yp) infection. He was transferred to our center because of impairment of renal function and altered consciousness. He had fever for 5 days after recurrent vomiting and diarrhea. Computed tomography scan was normal, but electroencephalogram (EEG) analyses showed generalized slow wave patterns. Continuous hemodialysis was undergone and then his renal function was improved, but altered consciousness persisted. Single photon emission computed tomography (SPECT) revealed abnormally low signals at entire field, which suggested that he was suffered from encephalopathy. Phenobarbital administration and post-encephalopathy rehabilitation were started, and he recovered in fully premorbid state with normal EEG and SPECT findings on the 33rd hospital day. Various bacterial cultures were negative, but both Yp antibody and Yp-derived mitogen (YPM) antibody, the antibody of a specific Yp exotoxin, had an extremely high titer. This is the first report of encephalopathy potentially caused by Yp, indicated by the presence of a high Yp and YPM antibody titer.
authors.affiliation: Department of Nephrology, National Center for Child Health and Development, Tokyo, Japan. hkaitoh@med.kobe-u.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kaito
authors.forename: Koichi
authors.initials: K
authors.lastname: Kamei
authors.forename: Masao
authors.initials: M
authors.lastname: Ogura
authors.forename: Eriko
authors.initials: E
authors.lastname: Kikuchi
authors.forename: Hideki
authors.initials: H
authors.lastname: Hoshino
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nakagawa
authors.forename: Kentaro
authors.initials: K
authors.lastname: Matsuoka
authors.forename: Jun
authors.initials: J
authors.lastname: Abe
authors.forename: Shuichi
authors.initials: S
authors.lastname: Ito
mesh_terms: D000208:Acute Disease; D000942:Antigens, Bacterial / Q000032:analysis; D001426:Bacterial Proteins / Q000097:blood; D001927:Brain Diseases / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004569:Electroencephalography; D006801:Humans; D008297:Male; D009395:Nephritis, Interstitial / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D015899:Tomography, Emission-Computed, Single-Photon; D015011:Yersinia pseudotuberculosis / Q000276:immunology* / Q000302:isolation & purification; D015012:Yersinia pseudotuberculosis Infections / Q000097:blood / Q000150:complications* / Q000382:microbiology
chemical_list: D000942:Antigens, Bacterial; D001426:Bacterial Proteins; C093313:Yersinia pseudotuberculosis-derived mitogen