Fulminating Meningitis Caused by Haemophilus Influenzae with Rapid Progression of Severe Brain Edema Similar to Acute Encephalopathy

DOI 18 References
  • Shirai Kentaro
    Department of Pediatrics, Tsuchiura Kyodo Hospital Department of Pediatrics, Yokohama Municipal Minato Red Cross Hospital
  • Nakajima Keisuke
    Department of Pediatrics, Tsuchiura Kyodo Hospital
  • Watanabe Akimitsu
    Department of Pediatrics, Tsuchiura Kyodo Hospital
  • Kawano Yutaka
    Department of Pediatrics, Yokohama Municipal Minato Red Cross Hospital
  • Sakuma Hiroshi
    Department of Child Neurology, National Center Hospital for Mental, Nervous and Muscular Disorders, National Center of Neurology and Psychiatry
  • Yoshida Takamasa
    Department of Pediatrics, Hitachi Mito General Hospital
  • Miyata Rie
    Department of Clinical Neuropathology, Tokyo Metropolitan Institute for Neuroscience
  • Tanuma Naoyuki
    Department of Clinical Neuropathology, Tokyo Metropolitan Institute for Neuroscience
  • Hayashi Masaharu
    Department of Clinical Neuropathology, Tokyo Metropolitan Institute for Neuroscience

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Other Title
  • 急性脳症に類似した急激な脳腫脹から臨床的脳死状態となったインフルエンザ菌髄膜炎の4歳男児例

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Abstract

  We report a 4-year-old boy with fulminating meningitis caused by Haemophilus influenzae (Hib). He suddenly developed fever, vomiting and then somnolence. As bacterial meningitis was suspected, treatment with antibiotics was started at 12 hours after the onset. However, there was arapid progression of severe brain edema and brain hernia, leading to clinical brain death. His clinical course and neuroradiological findings mimicked those in patients with acute encephalopathy, with cytokine profiles in cerebrospinal fluid demonstrating a marked increase of inflammatory cytokines. From a review of the literature, fulminating Hib meningitis may be classified into two disease types: DIC plus multiple organ failure and acute brain swelling types. The present case belongs to the latter type, in which cytokine storm seems to play an important pathogenic role.

Journal

  • NO TO HATTATSU

    NO TO HATTATSU 41 (6), 447-451, 2009

    The Japanese Society of Child Neurology

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