Mianwang He1, Dan Gao2, Jiatang Zhang3, Dehui Huang1, Yaping Tian4, Shengyuan Yu5. 1. Neurology Department, Chinese PLA General Hospital, 28# Fuxing Road, Beijing, People's Republic of China. 2. Medical School of Nankai University, 29# Weijing Road, Tianjin, People's Republic of China. 3. Neurology Department, Chinese PLA General Hospital, 28# Fuxing Road, Beijing, People's Republic of China. Electronic address: Edvin-zhang@263.net. 4. Medical School of Nankai University, 29# Weijing Road, Tianjin, People's Republic of China; Core Laboratory of Translational Medicine, State Key Laboratory of Kidney Disease, Chinese PLA General Hospital, 28# Fu-Xing Road, Beijing 100853, People's Republic of China. Electronic address: tianyp@301hospital.com.cn. 5. Neurology Department, Chinese PLA General Hospital, 28# Fuxing Road, Beijing, People's Republic of China; Medical School of Nankai University, 29# Weijing Road, Tianjin, People's Republic of China. Electronic address: yusy1963@126.com.
Abstract
BACKGROUND: Suspected bacterial meningoencephalomyelitis as the presentation or trigger of neuromyelitis optica spectrum disorders (NMOSD) flare has not been reported in literature. CASE PRESENTATION: A 29 year old female, who has a history of neuromyelitis optica spectrum disorder (NMOSD) for 6 years, presented with symptoms of meningitits, encephalitis, myelitis, headache and fever. Cerebrospinal fluid analysis revealed pleocytosis (1131 × 106/L [83% neutrophils]) and a glucose level of 39.6 mg/dl. Magnetic resonance imaging revealed lesions in the cervical cord, medulla, right frontal-parietal lobe, and corpus callosum. Serum anti-aquaporin-4 (AQP-4) antibody was positive. An initial diagnosis of bacterial meningoencephalomyelitis was considered. Despite broad-spectrum antimicrobial therapy, her neurologic symptom continued to deteriorate. Intravenous gamma immunoglobulin and methylprednisolone was initiated, which improved her symptoms rapidly. CONCLUSION: Suspected bacterial meningoencephalomyelitis as the presentation or trigger of NMOSD flare was considered in our case. Literature review revealed that bacterial meningitis-like presentation was a rare presentation in the attack phase of NMOSD. Corticosteroid therapy should be initiated in such cases.
BACKGROUND: Suspected bacterial meningoencephalomyelitis as the presentation or trigger of neuromyelitis optica spectrum disorders (NMOSD) flare has not been reported in literature. CASE PRESENTATION: A 29 year old female, who has a history of neuromyelitis optica spectrum disorder (NMOSD) for 6 years, presented with symptoms of meningitits, encephalitis, myelitis, headache and fever. Cerebrospinal fluid analysis revealed pleocytosis (1131 × 106/L [83% neutrophils]) and a glucose level of 39.6 mg/dl. Magnetic resonance imaging revealed lesions in the cervical cord, medulla, right frontal-parietal lobe, and corpus callosum. Serum anti-aquaporin-4 (AQP-4) antibody was positive. An initial diagnosis of bacterial meningoencephalomyelitis was considered. Despite broad-spectrum antimicrobial therapy, her neurologic symptom continued to deteriorate. Intravenous gamma immunoglobulin and methylprednisolone was initiated, which improved her symptoms rapidly. CONCLUSION: Suspected bacterial meningoencephalomyelitis as the presentation or trigger of NMOSD flare was considered in our case. Literature review revealed that bacterial meningitis-like presentation was a rare presentation in the attack phase of NMOSD. Corticosteroid therapy should be initiated in such cases.