Article in Japanese
Clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) and rhabdomyolysis caused by non-typhoidal Salmonella enterica in a 9-year-old boy
Masahiro KATO1), Hiroaki SHIKANO1)
Non-typhoidal Salmonella enterica, affects the intestinal tract, and is known to result in complications such as severe encephalitis. This study reported a case involving a 9-year-old boy demonstrating clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) and rhabdomyolysis caused by non-typhoidal Salmonella enterica. He suffered from fever, vomiting, diarrhea, and disturbed consciousness. His illness was diagnosed as rhabdomyolysis based on a creatine phosphokinase value of 4,549 IU/L and myoglobin in the urine. Salmonella O40 was detected in the stool culture. His state became stable by rapid infusion and antimicrobial treatment; however, his consciousness did not improve. MERS was diagnosed based on brain magnetic resonance imaging showing high-intensity lesions in the splenium of the corpus callosum. He received steroid pulse and γ-globulin massive-dose therapy in addition to supportive therapy. His level of consciousness improved gradually during the next day and he became alert after three days of hospitalization. He did not experience any neurologic sequelae. The mechanism of MERS onset is considered to be cytokines such as interleukin-6, interleukin-10, and interferon-γ. Elevated cytokine levels were noted accordingly in this case. Rhabdomyolysis occurs at a high rate in cases of Salmonella encephalitis. Hence, encephalitis and rhabdomyolysis have to be taken into account in patients with non-typhoidal Salmonella enterica, and close attention should be paid to changes in creatine phosphokinase value.
1) Department of Pediatrics, Ogaki Municipal Hospital
|Key words||non-typhoidal Salmonella enterica, MERS, rhabdomyolysis, AKI, hypercytokinemia|
|Received||February 22, 2018|
|Accepted||August 20, 2018|