Fulminant encephalopathy in a child with hyperferritinemic sepsis: a case report
Open Access
- 2 March 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Neurology
- Vol. 20 (1), 1-6
- https://doi.org/10.1186/s12883-020-01661-z
Abstract
Sepsis-associated encephalopathy (SAE) is epidemic in intensive care units and recognized as a fatal complication of sepsis. SAE is characterized by diffuse brain dysfunction and the correct diagnosis of SAE requires ruling out direct central nervous system (CNS) infection or other types of encephalopathy, such as hepatic encephalopathy, pulmonary encephalopathy, and other encephalopathy. We reported a rare case of a 5-year-old girl who presented with abdominal pain, vomiting, recurrent seizures, and coma. Brain magnetic resonance imaging (MRI) showed diffuse white matter abnormalities in the brain on day 1. Cerebrospinal fluid (CSF) tests revealed that protein levels and glucose levels were normal without pleocytosis. CSF PCRs for pathogens were all negative. The electroencephalography examination demonstrated diffuse, generalized and slow background activity. The patient showed the symptom of hyperferritinemic sepsis with multiple organ dysfunction syndrome (MODS). SAE was also diagnosed by ruling out other encephalitis or encephalopathy. The patient made marked improvements of clinical symptoms and the lesions on brain imaging disappeared completely within two months after appropriate treatment including antibiotic treatments, methylprednisolone, intravenous immunoglobulin, membrane-based therapeutic plasma exchange (TPE), and continuous renal replacement therapy (CRRT). SAE can be a fatal complication of sepsis which asks for immediate diagnosis and treatment. Few reports have focus on MRI imaging findings on the early onset of hyperferritinemic sepsis with MODS since these children were too ill to undergo an MRI scan. However, SAE might appear before other systemic features of sepsis are obvious, and MRI could show abnormal lesion in the brain during the early course. Therefore, MRI should be performed early to diagnose this fatal complication which would play important roles in improving the clinical outcomes by early initiation with appropriate treatments.Funding Information
- Medical Scientific Research Foundation of Guangdong Province, China (No. A2018009)
This publication has 17 references indexed in Scilit:
- A definition and classification of status epilepticus – Report of the ILAE Task Force on Classification of Status EpilepticusEpilepsia, 2015
- Therapeutic plasma exchange as rescue therapy in severe sepsis and septic shock: retrospective observational single-centre study of 23 patientsBMC Anesthesiology, 2014
- Encéphalopathie associée au sepsis (EAS), un cas pédiatriqueArchives de Pédiatrie, 2013
- Therapeutic plasma exchange in the management of sepsis and multiple organ dysfunction syndrome: A report of three casesJournal of Clinical Apheresis, 2013
- Deep coma and diffuse white matter abnormalities caused by sepsis-associated encephalopathyThe Lancet, 2013
- Sepsis-associated encephalopathyNature Reviews Neurology, 2012
- Sepsis-associated encephalopathy and its differential diagnosisCritical Care Medicine, 2009
- Fulminant Sepsis-Associated Encephalopathy in Two Children: Serial Neuroimaging Findings and Clinical CourseNeuropediatrics, 2009
- Intensive plasma exchange increases a disintegrin and metalloprotease with thrombospondin motifs-13 activity and reverses organ dysfunction in children with thrombocytopenia-associated multiple organ failure*Critical Care Medicine, 2008
- Brain lesions in septic shock: a magnetic resonance imaging studyIntensive Care Medicine, 2007