1998 Volume 5 Issue 2 Pages 141-148
We reported a case of severe encephalopathy encountered in an outbreak of Escherichia coli O-157 infection in Sakai, Osaka, Japan in 1996. We saw 1491 outpatients and had 16 hospitalized patients during this period. A seven-year-old girl with anuria, fragmentation of red blood cells, and low platelet count was diagnosed with hemolytic uremic syndrome (HUS). Her stool culture was positive for E. coli O-157: H7. Impaired consciousness with abnormal eye movement was noticed on referral from another hospital, but convulsion was not apparent. Brain computed tomography showed infarction in the genu of corpus callosum. Plasma exchange (PE) was instituted immediately against the verotoxin, followed by absorption of the endotoxin and continuous hemodialysis (CHD). Mechanical ventilation and catecholamine support were also instituted. But multiple brain infarctions progressed and the electroencephalogram was almost flat in 3 days. Increased vascular permeability caused pericardial and pleural effusions along with acute cardiomyopathy and pulmonary edema. The patient recovered from multiple organ failure after 20 days of illness, but did not recover brain functions. Urine output increased eliminating the need for CHD. The patient remained in a coma, however, and died after 205 days of illness. PE and absorption of the endotoxin were not effective against encephalopathy.
