Images in Clinical Medicine
Bilateral Striatal Necrosis Associated with Mycoplasma pneumoniae Infection
N Engl J Med 2003; 348:720February 20, 2003
- Article
Fever and neutropenia developed in a 14-year-old girl after she received intensive chemotherapy for her third relapse of pre–B-cell acute lymphocytic leukemia, including intrathecal therapy with methotrexate, cytarabine, and prednisone. She had headache, nausea, and photophobia and became increasingly confused and somnolent; a chest radiograph showed an interstitial pattern. A T2-weighted magnetic resonance imaging (MRI) scan of her skull (with fluid-attenuated inversion recovery) showed high-signal lesions involving all basal ganglia except the thalami (Panel A). The cerebrospinal fluid protein level was markedly increased. A polymerase-chain-reaction assay for Mycoplasma pneumoniae in cerebrospinal fluid was negative. Although the serum IgM antibody titer rose to 1:16 within a four-week period, the IgG level was undetectable (<10 U per liter). She was treated with doxycycline. The interstitial pattern on chest radiographs persisted for three weeks. Transient hyperphagia developed, and then there was complete neurologic recovery. An MRI scan obtained two months later showed marked atrophy of the basal ganglia and postnecrotic defects of the caudate (Panel B, arrows). At that point, serum IgG and IgM tests were negative.
The cause of an acute onset of bilateral striatal necrosis with a favorable neurologic outcome is often unknown. We suggest that, in our severely immunocompromised patient, the bilateral striatal necrosis may have been due to M. pneumoniae.
Miriam van Buiren, M.D.
Markus Uhl, M.D.
University Children's Hospital, 79106 Freiburg, Germany- Citing Articles (1)
Citing Articles
1
Zhen-Ni Guo, Hong-Liang Zhang, Jing Bai, Jiang Wu, Yi Yang. (2011) Meningitis associated with bilateral optic papillitis following Mycoplasma pneumoniae infection. Neurological Sciences
CrossRef
