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Article in Japanese

A case of acute rotavirus encephalopathy without seizure treated with thyrotropin-releasing hormone

Nazuna HOMMA1), Chikara OGIMI1), Tadamasa TAKANO1), Risa TANAKA1), Tsutomu OISHI1), Manabu TANAKA2), Eiji OGUMA3)

Rotavirus is one of the major causes of enteritis in children. Recently, reports of central nervous system complications have been increasing. However, no standard therapy has yet been established.
We report here a 2-year-old girl with rotavirus-related encephalopathy who was treated with thyrotropin-releasing hormone (TRH). The infant demonstrated impaired consciousness, speech disturbance and hypotonic muscle tone, but there were no seizures throughout the course of the illness. Just before her neurological symptoms developed, she had been diagnosed with rotavirus enteritis at a local clinic based on gastrointestinal symptoms and rotavirus-positive stool. Neuron-specific enolase, interleukin-6 and tumor necrosis factor alpha were elevated in the cerebrospinal fluid and hyperintensity on diffusion-weighted magnetic resonance imaging in the cerebellar cortex were observed. The diagnosis of rotavirus-related encephalopathy was made. Intravenous steroid administration did not improve her conditions and we started TRH therapy. Her neurological symptoms gradually improved but speech disturbance and wide-based gait persisted.
TRH is thought to act as a neurotransmitter or neuroregulator and to increase the blood flow in the central nervous system and has been used to treat neurological disorders such as spinocerebellar degeneration or West syndrome.
Our case indicates that TRH therapy may also be useful in treating rotavirus encephalopathy. Some cases of virus-related encephalopathy that are not accompanied by seizure have been reported. Physicians should be careful when evaluating the state of consciousness in patients with gastrointestinal symptoms.

1) Division of Infectious Disease and Immunology, Saitama Childrens Medical Center
2) Division of Neurology, Saitama Childrens Medical Center
3) Division of Radiology, Saitama Childrens Medical Center

Key words
Received April 8, 2010
Accepted October 16, 2010

23 (1):23─28,2011