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A 76‐year‐old man who developed febrile unconsciousness with magnetic resonance imaging findings indicating encephalitis
Author(s) -
Nakano Imaharu,
Aita Kiyoshi,
Shiga Junji
Publication year - 2005
Publication title -
neuropathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.701
H-Index - 61
eISSN - 1440-1789
pISSN - 0919-6544
DOI - 10.1111/j.1440-1789.2005.00614.x
Subject(s) - medicine , glasgow coma scale , prothrombin time , liver function , anesthesia , jaundice , unconsciousness , gastroenterology , hepatitis , prednisolone , encephalopathy , coagulopathy
On 24 April 2002, a 76-year-old man who had suffered acute hepatitis during his childhood underwent a medical examination that revealed abnormal liver function. Two days later, he consulted a doctor at the Hospital of Teikyo University School of Medicine; his serum AST was 1468 IU/L, ALT 1232 IU/L, g-GTP 316 IU/L, ALP 510 IU/ L, total bilirubin 2.7 mg/dL, and direct bilirubin 1.7 mg/dL. He was admitted to the Hospital on the same day. The patient was alert, and he was jaundiced without edema. His pulse rate was 72/min. Neither his liver nor spleen were palpable. On 11 May, he developed nasal bleeding. Because the plasma prothrombin time (%) was low (32%), a pulse therapy with methyl prednisolone was started. Three days later, he developed hepatic encephalopathy, grade II, with a diagnosis of subacute fulminant hepatitis. Disseminated intravascular coagulopathy also occurred. Plasma exchange was done from 15 May to 24 May, with the patient becoming alert on 23 May. On the evening of 10 June 2002, a high fever (39.2∞C) and abnormal behavior with mild consciousness disturbance (Japan Coma Scale I-2) developed. An EEG on 10 June revealed spike-and-wave complexes in the left cerebral hemisphere, and diffusion-weighted MRI of the head demonstrated high-intensity lesions essentially confined to the bilateral insular cortex (Fig. 1). With these findings combined, a diagnosis of encephalitis was made, although the lumbar puncture could not be performed because of the bleeding tendency. In spite of immediately started acyclovir, the patient’s condition deteriorated rapidly, resulting in deep coma on 14 June. He died on 20 June, only 10 days after the onset of symptoms of encephalitis. The laboratory examination showed that hepatitis A IgM antibody and antigen, hepatitis C virus RNA, Epstein–Barr virus antibody, and cytomegalovirus antibody were negative.