Dados do Trabalho

Título

ENCEPHALOMYELITIS BY ADENOVIRUS

Apresentação do caso

Three-year-old male admitted with aphasia and mental confusion that last 48 hours. Reporta fever peak of 38ºC. Vomiting and hyaline rhinorrhea resolved four days ago. Plusdiarrhoeal symptoms three weeks prior to hospitalization. He did notrecognize his mother and other family members, he was frightened by environmental stimuli,he could not walk, he fell if placed standing and did not sit without support. Previously healthy. History of febrile seizures at 1 year of age on sodium valproate. Proper motor development, but with speech delay. Son of a healthy couple non-consanguineous fromManaus, attended day care with good socialization. On examination he was awake but disoriented, cranial nerves unaltered. He presented traction of the lower limbs with flexion of the thigh to painful stimuli and spontaneous elevation of the lower limbsagainst gravity, without signs of pyramidal release with bilateral patellar areflexia. Lumbarpuncture showed cellularity of 27 and predominance of lymphocytes, protein 19, glucose 51and lactate 1.4. Normal metabolic tests and cranial tomography. Started acyclovir andrequested panel for viral meningitis in the cerebrospinal fluid (CSF). The following day, heprogressed with worsening, dysphagia and loss of head support, he maintained the lowerlimb areflexia, being referred to the ICU where he received immunoglobulin. He wasdischarged from the ICU after 48 hours with improvement. Ophthalmologic evaluation andEEG were normal. Neuroaxis MRI showed bilateral and symmetrical signal alteration in theposterior region of the brainstem, more evident in the bulbopontine region with insinuation tothe dentate nucleus of the cerebellar hemispheres, without anomalous contrastimpregnation, suggesting viral or autoimmune etiology. Therefore, it was chosen to repeatthe lumbar puncture with normal CSF (4 cells). The patient evolved with recovery of consciousness and neurotendinous reflexes. The CSF panel showed positive PCR for adenovirus. The patient was discharged asymptomatic, and acyclovir was discontinued.

Discussão

Adenovirus infection is a rare cause of viral meningoencephalitis. Involvement ranges from reversible meningitis to fatal necrotizing encephalopathy.

Comentários finais

Isolation of the agent in CSF orother body fluids is essential and avoids unnecessary treatments and tests as well as favors the possibility of specific antiviraltherapy .

Referências (se houver)

Alcamo AM, Wolf MS, Alessi LJ, et al. Successful Use of Cidofovir in an Immunocompetent Child With Severe Adenoviral Sepsis. Pediatrics. 2020;145(1):e20191632. doi:10.1542/peds.2019-1632Schwartz KL, Richardson SE, MacGregor D, Mahant S, Raghuram K, Bitnun A. Adenovirus-Associated Central Nervous System Disease in Children. J Pediatr. 2019;205:130-137. doi:10.1016/j.jpeds.2018.09.03

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