TAILIEUCHUNG - báo cáo khoa học: "Unusual exanthema combined with cerebral vasculitis in pneumococcal meningitis: a case report"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Unusual exanthema combined with cerebral vasculitis in pneumococcal meningitis: a case report | Tavladaki et al. Journal of Medical Case Reports 2011 5 410 http content 5 1 410 JOURNALOF medical Ur Case REPORTS CASE REPORT Open Access Unusual exanthema combined with cerebral vasculitis in pneumococcal meningitis a case report 1 11 12 Theonimfi Tavladaki Anna-Maria Spanaki Stavroula Ilia Elisabeth Geromarkaki Maria Raissaki and George Briassoulis 1 Abstract Introduction Bacterial meningitis is a complex rapidly progressive disease in which neurological injury is caused in part by the causative organism and in part by the host s own inflammatory responses. Case presentation We present the case of a two-year-old Greek girl with pneumococcal meningitis and an atypical curvilinear-like skin eruption chronologically associated with cerebral vasculitis. A diffusion-weighted MRI scan showed lesions with restricted diffusion reflecting local areas of immunologically mediated necrotizing vasculitis. Conclusions Atypical presentations of bacterial meningitis may occur and they can be accompanied by serious unexpected complications. Introduction Neurological injury in Streptococcus pneumoniae meningitis can be due to meningeal inflammation cerebral edema necrosis and intracranial hemorrhage. There is a widely held belief that cerebral infarction after bacterial meningitis is always caused by vasculitis however evidence for this is weak. Vergouwen et al. hypothesized that diffuse cerebral intravascular coagulation is an additional explanation for cerebral infarction in patients with pneumococcal meningitis 1 . At the molecular level S. pneumoniae cell walls have been shown to induce cerebrovascular endothelial cells microglia and meningeal inflammatory cells to release cytokines chemokines and reactive oxygen species 2 . These include tumor necrosis factor a interleukins 1 and 6 platelet-activating factor peroxynitrites matrix metalloproteinases and urokinase plasminogen activator. Release of such bioproducts is believed to play a role in the .

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