title: Chronic meningitis with intracranial hypertension and bilateral neuroretinitis following Mycoplasma pneumoniae infection.
abstract: A previously well 12-year-old boy presented with a 2-week history of headache, nausea, vomiting and left-sided weakness. He subsequently developed meningism, right abducens nerve palsy, persistent papilloedema and reduced visual acuity in association with a bilateral macular star, consistent with neuroretinitis. Cerebrospinal fluid (CSF) examination indicated chronic meningitis and serological testing confirmed recent Mycoplasma pneumoniae infection, although PCR in CSF was negative. He was treated for aseptic meningitis with ceftriaxone, aciclovir, azithromycin and acetazolamide for intracranial hypertension, with gradual improvement in clinical condition and visual acuity over several weeks. This is the first report of M. pneumoniae chronic meningitis further complicated with bilateral neuroretinitis and intracranial hypertension. Evidence of central nervous system inflammation in the absence of direct infection suggests an immune-mediated pathophysiology. Although the use of macrolides with antibiotic and immunomodulatory activity might be beneficial, it was not possible to ascertain whether it influenced clinical recovery in this case.
authors.affiliation: Department of Paediatrics, The Royal London Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Karampatsas
authors.affiliation: Department of Ophthalmology, The Royal London Hospital, Barts Health NHS Trust, London, UK Moorfields Eye Hospital, London, UK.
authors.forename: Himanshu
authors.initials: H
authors.lastname: Patel
authors.affiliation: Department of Paediatric Neurology, The Royal London Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Sheikh N
authors.initials: SN
authors.lastname: Basheer
authors.affiliation: Centre for Paediatrics, Blizard Institute, Queen Mary University of London, London, UK.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Prendergast
mesh_terms: D020434:Abducens Nerve Diseases / Q000175:diagnosis / Q000209:etiology; D002648:Child; D006261:Headache / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology; D006801:Humans; D007249:Inflammation / Q000175:diagnosis / Q000209:etiology; D019586:Intracranial Hypertension / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008581:Meningitis / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D008582:Meningitis, Aseptic / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D009175:Mycoplasma Infections / Q000134:cerebrospinal fluid / Q000150:complications* / Q000276:immunology / Q000382:microbiology; D009177:Mycoplasma pneumoniae; D010211:Papilledema / Q000175:diagnosis / Q000209:etiology; D012160:Retina / Q000473:pathology*; D012173:Retinitis / Q000175:diagnosis / Q000209:etiology*; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology