title: Marked elevation of interleukin-6 in mild encephalopathy with a reversible splenial lesion (MERS) associated with acute focal bacterial nephritis caused by Enterococcus faecalis.
abstract: This report describes two cases of mild encephalitis/encephalopathy with reversible splenial lesion (MERS) associated with acute focal bacterial nephritis (AFBN). The patients, who presented with fever and delirious behavior, exhibited hyponatremia and markedly elevated interleukin (IL)-6 in cerebrospinal fluid (CSF) and serum. Enterococcus faecalis was detected in the urine culture. After ampicillin treatment, their consciousness improved without neurological sequelae. Moreover, a diffusion-weighted MRI abnormality, i.e., intensified signals in splenium of the corpus callosum, disappeared. MERS is a possible complication of AFBN. Elevated CSF IL-6 levels suggest that remote activation of intracerebral immune response through the immune-neuroendocrine pathway might play an important role in the pathophysiology of MERS.
authors: Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan. Electronic address: hkometa@hotmail.co.jp.
authors: Hiroshi
authors: H
authors: Kometani
authors: Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors: Masao
authors: M
authors: Kawatani
authors: Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors: Genrei
authors: G
authors: Ohta
authors: Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors: Shintaro
authors: S
authors: Okazaki
authors: Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors: Kazumasa
authors: K
authors: Ogura
authors: Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors: Motoko
authors: M
authors: Yasutomi
authors: Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors: Akihiko
authors: A
authors: Tanizawa
authors: Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors: Yusei
authors: Y
authors: Ohshima
mesh_terms: D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D003337:Corpus Callosum / Q000187:drug effects / Q000473:pathology; D003937:Diagnosis, Differential; D004660:Encephalitis / Q000188:drug therapy / Q000378:metabolism* / Q000473:pathology; D013293:Enterococcus faecalis; D016908:Gram-Positive Bacterial Infections / Q000378:metabolism*; D006801:Humans; D015850:Interleukin-6 / Q000378:metabolism*; D008279:Magnetic Resonance Imaging; D008297:Male; D009393:Nephritis / Q000188:drug therapy / Q000378:metabolism* / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015850:Interleukin-6; D000667:Ampicillin
keywords: Acute focal bacterial nephritis; Corpus callosum; Cytokine; Encephalitis; Encephalopathy; Splenium