Mycoplasma pneumoniae Intrathecal Antibody ...

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Jun 20, 2013 - manifested meningism, ataxia, ophthalmoplegia, left-sided hemiplegia, and eventually coma within 24 hours. The analysis of cerebrospinal ...

Short Communication

Mycoplasma pneumoniae Intrathecal Antibody Responses in Bickerstaff Brain Stem Encephalitis Patrick M. Meyer Sauteur1,6 Christa Relly1,6 Annette Hackenberg2,6 Nikolai Stahr3,6 Christoph Berger1,6 Guido V. Bloemberg4 Enno Jacobs5 David Nadal1,6 1 Division of Infectious Diseases and Hospital Epidemiology, University

Children’s Hospital of Zurich, Zurich, Switzerland 2 Division of Neurology, University Children’s Hospital of Zurich, Zurich, Switzerland 3 Division of Radiology, University Children’s Hospital of Zurich, Zurich, Switzerland 4 Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland 5 Institute of Medical Microbiology and Hygiene, Medical Faculty Carl Gustav Carus, Dresden University of Technology, Dresden, Germany 6 Children’s Research Center (CRC), University Children’s Hospital of Zurich, Zurich, Switzerland

Address for correspondence Dr. Patrick M. Meyer Sauteur, MD, Division of Infectious Diseases and Hospital Epidemiology, University Children’s Hospital of Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland (e-mail: [email protected]).

Neuropediatrics 2014;45:61–63.

Abstract Keywords

► Mycoplasma pneumoniae ► encephalitis ► Bickerstaff brain stem encephalitis ► cerebrospinal fluid ► intrathecal antibody synthesis

The pathogenesis of Mycoplasma pneumoniae encephalitis is not established. We report, for the first time, the case of a patient with severe Bickerstaff brain stem encephalitis in whom we detected intrathecal production of M. pneumoniae–specific antibodies, contrasting the findings in another patient with less severe encephalitis in whom we detected intrathecal M. pneumoniae DNA but no specific antibodies. Our observations suggest that intrathecal M. pneumoniae–specific antibody responses may contribute to a more severe course of M. pneumoniae encephalitis.

Introduction Mycoplasma pneumoniae is a leading cause of encephalitis in children.1 The paucity of reports on M. pneumoniae isolation from or detection in the central nervous system (CNS) favors the hypothesis that M. pneumoniae encephalitis (MPE) is caused by an immune-mediated inflammation.2 The inflammation may be induced by molecular mimicry between M. pneumoniae and neuronal cell components.3 We recently reported on the case of a 15-year-old girl with self-limiting MPE showing microbial CNS invasion but no intrathecal-specific antibody responses (►Table 1, Case 1). Therefore, we speculated that intrathecal antibody responses

received February 16, 2013 accepted after revision April 20, 2013 published online June 20, 2013

might be present in more severe MPE.4 Here, we report on a contrasting case of a patient with MPE with neurologic sequelae who indeed showed detectable intrathecal-specific antibody responses.

Case Presentation A 9-year-old boy was admitted in November 2012 to our hospital with a 3-week history of respiratory symptoms followed by headache and drowsiness (►Table 1, Case 2). He manifested meningism, ataxia, ophthalmoplegia, left-sided hemiplegia, and eventually coma within 24 hours. The analysis of cerebrospinal fluid (CSF) revealed 11 white blood cells/μL,

© 2014 Georg Thieme Verlag KG Stuttgart · New York

DOI http://dx.doi.org/ 10.1055/s-0033-1348150. ISSN 0174-304X.

61

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Intrathecal Antibody Responses in Mycoplasma pneumoniae Encephalitis

Meyer Sauteur et al.

Table 1 Microbiological and clinical data for two patients with confirmed Mycoplasma pneumoniae encephalitis Diagnosis

Case 1: 15-year-old girl4 Meningoencephalitis

Case 2: 9-year-old boy Bickerstaff brain stem encephalitis

Prodromal respiratory symptoms (duration)

Cough and fever (2 weeks)

Cough and runny nose (3 weeks)

Pulmonary infiltrate (chest radiograph)

Yes

Yes

White blood cell count (4.5–13.5  109/L)

11.7  109/L (neutrophils 79%)

6.8  109/L (neutrophils 70%)

C-reactive protein (

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