Article in Japanese
Reversible lesion in the splenium of corpus callosum associated with toxic shock syndrome: a case report
Shinjiro HORIKAWA, Hirokazu KANEGANE, Keiko NOMURA, Toshio MIYAWAKI
A 9-year-old girl presented with fever, skin eruption and disturbance of consciousness. Toxic shock syndrome (TSS) was suspected although she did not have hypotension, because purulent discharge from the impetigo on the back of the right axillar showed gram positive cocci indicating staphylococci. Subsequently, flow cytometry was performed to analyze T-cell receptor (TCR) repertories of the peripheral blood T cells. The result revealed that TCR
Vβ2+ T cells had strongly increased (about 18%; normal value: 10% or lower), and the patient was diagnosed with TSS. On the first day of admission, magnetic resonance images (MRI) of diffusion-weight disclosed hyperintensity in the splenium of the corpus callosum (SCC). The disturbance of consciousness disappeared within a few days with antimicrobial treatment, and the hyperintensity lesion of the SCC returned to normal in MRI images taken on the 9th day.
An MRI finding of a discrete focal nonhemorrhagic lesion in the central portion of the SCC is a rarely found in clinical practice. The reason for the transiently decreased diffusion in the lesions remains unclear, as almost all reported cases were described as having encephalopathy secondary to virus infections. This is the first reported case of TSS associated with reversible lesion in SCC.
Department of Pediatrics, Graduate School of Medicine, University of Toyama
|September 14, 2010
|January 20, 2011