Clinically mild encephalitis/encephalopathy with a reversible splenial lesion associated with febrile urinary tract infection.
Common pathogens of clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) are viruses, such as influenza virus. However, bacteria are rare pathogens for MERS. We report the first patient with MERS associated with febrile urinary tract infection. A 16-year-old lupus patient was admitted to our hospital. She had fever, headache, vomiting, and right back pain. Urinary analysis showed leukocyturia, and urinary culture identified Klebsiella pneumoniae. Cerebrospinal fluid examination and brain single-photon emission computed tomography showed no abnormalities. Therefore, she was diagnosed with febrile urinary tract infection. For further examinations, 99mTc-dimercaptosuccinic acid renal scintigraphy showed right cortical defects, and a voiding cystourethrogram demonstrated right vesicoureteral reflux (grade II). Therefore, she was diagnosed with right pyelonephritis. Although treatment with antibiotics administered intravenously improved the fever, laboratory findings, and right back pain, she had prolonged headaches, nausea, and vomiting. T2-weighted, diffusion-weighted, and fluid attenuated inversion recovery images in brain magnetic resonance imaging showed high intensity lesions in the splenium of the corpus callosum, which completely disappeared 1 week later. These results were compatible with MERS. To the best of our knowledge, our patient is the first patient who showed clinical features of MERS associated with febrile urinary tract infection.


CONCLUSIONS
In patients with pyelonephritis and an atypical clinical course, such as prolonged headache, nausea, vomiting, and neurological disorders, the possibility of MERS should be considered.
Department of Pediatrics, Hokkaido University Graduate School of Medicine, N15, W7, Sapporo, 060-8638, Japan, okamon@med.hokudai.ac.jp.
Takayuki
T
Okamoto
Yasuyuki
Y
Sato
Takeshi
T
Yamazaki
Asako
A
Hayashi
D000293:Adolescent; D004679:Encephalomyelitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D005334:Fever / Q000382:microbiology*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000000981:diagnostic imaging; D007710:Klebsiella Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000302:isolation & purification*; D008279:Magnetic Resonance Imaging; D011239:Prednisolone / Q000627:therapeutic use; D011704:Pyelonephritis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D016559:Tacrolimus / Q000627:therapeutic use; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D014552:Urinary Tract Infections / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D011239:Prednisolone; D016559:Tacrolimus