MERS type II mimicking leukoencephalopathy was suspected to be associated with mycoplasma pneumonia infection

Abstract

A 16-year-old male with language disorders, such as motor aphasia or mutism, was hospitalized on day 4 after the onset of fever. Magnetic resonance imaging (MRI) on admission revealed lesions of the corpus callosum and brain white matter. Brain single photon emission computed tomography (99mTc-ethyl cysteinate dimer) on day 7 shows hypoperfusion (with right dominance) of bilateral upper parietal region. His condition improved gradually with symptomatic treatments alone, and he was discharged on day 13. The lesions on the MRI disappeared by day 15. Although this case might have suffered from leukoencephalopathy, clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) type II was suspected from the reversible splenial lesion. Except for the elevation (640 times) of mycoplasma pneumonia antibody titer (particle agglutination) in the serum, the blood tests and cerebrospinal fluid findings showed no significant abnormalities. We then considered this encephalopathy was related to mycoplasma pneumonia infection. Since no symptoms of mycoplasma infection except for neurologic symptoms were observed, indirect mechanism, such as immune-mediated reactions, is suggested to cause encephalopathy in this case.