EP218 - POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME: A RARE COMPLICATION OF INVASIVE PNEUMONOCOCCAL INFECTION (ID 1080)
Abstract
Title of Case:
POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME: A RARE COMPLICATION OF INVASIVE PNEUMONOCOCCAL INFECTION
Background:
Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological entity, presented with altered consciousness, hypertension and characterized by white matter vasogenic edema.
Case Presentation Summary:
A 22-month old febrile infant was referred to our hospital for altered mental status, vomiting and poor feeding with otitis media. Clinical examination revealed nuchal rigidity and Kernig’s sign, suggestive of central nervous system involvement. Based on presumed diagnosis of bacterial meningitis, she was immediately treated with iv dexamethasone and ceftriaxone. A lumbar puncture (LP) was performed, cerebrospinal fluid (CSF) analysis demonstrated low glucose level (<1 mg/dl), elevated protein concentration and a leukocyte count of 200cells/µL. Gram stain of the CSF revealed Gram-positive diplococci. Culture and Polymerase chain reaction (PCR) tests of the CSF and blood were positive for Streptococcus pneumoniae with penicillin MIC 0.06 mg/l (susceptible). Although, her clinical condition gradually improved, on hospital day 4 her clinical condition worsened, with hypertension (Blood Pressure 145/80mmHg), generalized hypotonia, lethargy and diminished spontaneous speech. A brain MRI and repeat LP were performed to rule out any complication of the disease.T2/FLAIR (fluid-attenuated inversion recovery) images showed bilateral subcortical lesions consistent with vasogenic edema and posterior reversible encephalopathy syndrome (PRES). Mannitol was added. She recovered and completed the antibiotic treatment for ten days and discharged. Serotyping revealed a non-vaccine serotype 15A. Follow-up MRI (T2 and FLAIR) revealed complete resolution of the previous diffuse, hyperintense lesions, confirming the diagnosis of PRES.
Learning Points/Discussion:
PRES is a rare complication of invasive pneumonococcal disease (IPD) and should be promptly recognized since it is reversible and treatable. The occurrence of IPD with serotype replacement not included in the PCV-vaccine needs further monitoring.
