NEUROINFECTION

The patient was a 2-month-old boy who was treated for 21 days with antimicrobial therapy for bacterial meningitis caused by Escherichia coli, starting at 13 days of age. On the third day after completing treatment, he developed fever and apnea, followed by seizures. Cerebrospinal fluid (CSF) examination revealed elevated cell count and protein levels and decreased sugar levels. We diagnosed a relapse of bacterial meningitis. Due to the prolonged and intense inflammatory response resulting from the complication of subdural edema, the optimal duration of antimicrobial therapy was unclear. The duration of treatment was determined using an elevated CSF glucose/blood glucose ratio as an indicator for ending therapy. The patient has not experienced a relapse. The appropriate index for determining the duration of antimicrobial therapy remains to be elucidated. Herein, we report this case and review the usefulness of the CSF glucose/blood glucose ratio as a marker.

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Anti-N-methyl-D-aspartate（NMDA）receptor encephalitis is an autoimmune encephalitis that manifests as neuropsychiatric symptoms, including psychiatric disturbances and involuntary movements, typically following an infection. Herein, we report the case of a 3-year-old girl who presented with recurrent afebrile seizures without any preceding symptoms. The patient experienced seizures 18, 13, and 6 days before admission, with clear consciousness during the interictal periods. Electroencephalography and magnetic resonance imaging of the brain revealed no abnormalities. Two days before admission, the patient developed psychiatric symptoms and involuntary movements. Based on various examinations conducted after admission, autoimmune encephalitis was diagnosed, and treatment was initiated. Subsequently, cerebrospinal fluid analysis confirmed the presence of anti-NMDA receptor antibodies, which led to a definitive diagnosis of anti-NMDA receptor encephalitis. In pediatric cases, even in the absence of typical onset patterns, early treatment should be considered when neuropsychiatric symptoms, such as psychiatric disturbances and involuntary movements, are observed, with anti-NMDA receptor encephalitis included as a differential diagnosis.

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We report an 80-year-old man with subarachnoid hemorrhage due to varicella-zoster virus（VZV）vasculopathy during antiviral therapy for VZV encephalopathy. The patient was transferred to our hospital because of fever and disturbance of consciousness. His cerebrospinal fluid（CSF）revealed monocyte dominant pleocytosis and elevated protein and was positive for VZV-DNA PCR, therefore intravenous acyclovir（ACV）was administered. On hospital day 8, he presented with headache, fever and deterioration of consciousness. His CSF showed xanthochromia and there was mild subarachnoid hemorrhage without any cerebral aneurysm on his head CT. He was diagnosed with VZV vasculopathy and added intravenous methylprednisolone therapy on ACV. He recovered and returned to work eight months after the onset. Based on previous studies, a better prognosis for VZV vasculopathy was inferred with the addition of prednisolone than with ACV monotherapy, therefore patients with VZV encephalitis need to be assessed for complications of VZV vasculopathy.

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