Document Type : Case Report(s)
Authors
1 Department of Pediatrics, Dr. Sheikh Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
2 Department of Pediatrics & Infection Control and Hand Hygiene Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Abstract
Acute hemorrhagic leukoencephalitis (AHLE) is a rare demyelinating disease characterized by an acute rapidly progressive fulminant inflammation of the white matter. In this case report, we introduce a case of AHLE in children with an interesting and lengthy process and successful treatment.A previously healthy 13-year-old girl was admitted to the hospital because of fever and loss of consciousness. After 4 days, she was referred to our pediatric intensive care unit in Mashhad, Iran. On admission, she had right-sided parotiditis. With a diagnosis of AHLE, our patient was treated with methylprednisolone, intravenous immunoglobulin, acyclovir, and plasmapheresis.AHLE is a rare and severe demyelinating disease, the mortality and morbidity of which can be decreased by early detection and treatment with steroid therapy, intravenous immunoglobulin, acyclovir, and plasmapheresis.
Keywords
- - Lee NK, Lee BH, Hwang YJ, Kim SY, Lee JY, Joo M. Serial computed tomography and magnetic resonance imaging findings of biphasic acute hemorrhagic leukoencephalitis localized to the brain stem and cerebellum. Jpn J Radiol. 2011;29:212-6. doi: 10.1007/s11604-010-0523-0. PubMed PMID: 21519996.
- - Palace J. Acute disseminated encephalomyelitis and its place amongst other acute inflammatory demyelinating CNS disorders. J Neurol Sci. 2011;306:188-91. doi: 10.1016/j.jns.2011.03.028. PubMed PMID: 21664525.
- - Takeda H, Isono M, Kobayashi H. Possible acute hemorrhagic leukoencephalitis manifesting as intracerebral hemorrhage on computed tomography--case report. Neurol Med Chir (Tokyo). 2002;42:361-3. doi: 10.2176/nmc.42.361. PubMed PMID: 12206493.
- - Kumar RS, Kuruvilla A. Teaching NeuroImages: Acute hemorrhagic leukoencephalitis after mumps. Neurology. 2009;73:e98. doi: 10.1212/WNL.0b013e3181c2eee3. PubMed PMID: 19917982.
- - Befort P, Gaillard N, Roubille C, Quellec AL. Hemorrhagic leukoencephalitis linked to Epstein-Barr virus in an adult patient. Clin Neurol Neurosurg. 2010;112:829-31. doi: 10.1016/j.clineuro.2010.06.017. PubMed PMID: 20667422.
- - Francisci D, Sensini A, Fratini D, Moretti MV, Luchetta ML, Di Caro A, et al. Acute fatal necrotizing hemorrhagic encephalitis caused by Epstein-Barr virus in a young adult immunocompetent man. J Neurovirol. 2004;10:414-7. doi: 10.1080/13550280490521050. PubMed PMID: 15765813.
- - Martins HM, Teixeira AL, Jr., Lana-Peixoto MA, Brazilian Committee for T, Research in Multiple S. Acute hemorrhagic leukoencephalitis mimicking herpes simplex encephalitis: case report. Arq Neuropsiquiatr. 2004;62:139-43. doi: 10.1590/S0004-282X2004000100024. PubMed PMID: 15122448.
- - Lee HY, Chang KH, Kim JH, Na DG, Kwon BJ, Lee KW, et al. Serial MR imaging findings of acute hemorrhagic leukoencephalitis: a case report. AJNR Am J Neuroradiol. 2005;26:1996-9. PubMed PMID: 16155148.
- - de Seze J, Debouverie M, Zephir H, Lebrun C, Blanc F, Bourg V, et al. Acute fulminant demyelinating disease: a descriptive study of 60 patients. Arch Neurol. 2007;64:1426-32. doi: 10.1001/archneur.64.10.1426. PubMed PMID: 17923626.
- - Jayakrishnan MP, Krishnakumar P. Clinical profile of acute disseminated encephalomyelitis in children. J Pediatr Neurosci. 2010;5:111-4. doi: 10.4103/1817-1745.76098. PubMed PMID: 21559154; PubMed Central PMCID: PMC3087985.
- - Leake JA, Billman GF, Nespeca MP, Duthie SE, Dory CE, Meltzer HS, et al. Pediatric acute hemorrhagic leukoencephalitis: report of a surviving patient and review. Clin Infect Dis. 2002;34:699-703. doi: 10.1086/338718. PubMed PMID: 11810602.
- - Meilof JF, Hijdra A, Vermeulen M. Successful recovery after high-dose intravenous methylprednisolone in acute hemorrhagic leukoencephalitis. J Neurol. 2001;248:898-9. doi: 10.1007/s004150170076. PubMed PMID: 11697528.
- - Ryan LJ, Bowman R, Zantek ND, Sherr G, Maxwell R, Clark HB, et al. Use of therapeutic plasma exchange in the management of acute hemorrhagic leukoencephalitis: a case report and review of the literature. Transfusion. 2007;47:981-6. doi: 10.1111/j.1537-2995.2007.01227.x. PubMed PMID: 17524086.
- - Sonneville R, Klein IF, Wolff M. Update on investigation and management of postinfectious encephalitis. Curr Opin Neurol. 2010;23:300-4. doi: 10.1097/WCO.0b013e32833925ec. PubMed PMID: 20442573.
- - Tenembaum S, Chitnis T, Ness J, Hahn JS, International Pediatric MSSG. Acute disseminated encephalomyelitis. Neurology. 2007;68:S23-36. doi: 10.1212/01.wnl.0000259404.51352.7f. PubMed PMID: 17438235.