Background and Aims Nine year old boy admitted with meningeal syndrome. six days ago began with fever being treated with azithromycin. three days before entering a high fever, bilious vomiting, no diarrhea, the next day associated dizziness, headache, drowsiness, the day before admission diplopia and pain associated neck.
Strikes disease, no rashes or petechiae.
Methods Hemogram: 13.24 leukocytes, neutrophils 87.4%
Cerebrospinal fluid red blood cells 160/mmc 30/mmc polynuclear leukocytes 5%, lymphocytes 95%, Gram negative, PCR Herpes simplex I and II negative, negative enterovirus, varicella zoster negative. Negative blood cultures, Mantoux negative.
Abnormal EEG tracing during wakefulness slow waves of high amplitude delta, acute, which are located in anterior and temporal area.
RMN ill-defined hyperintense areas in pons, cerebellum, basal ganglia, right parietal subcortical white matter. suspected encephalitis retrovirus by areas of parenchymal signal alteration above and infratentorial level.
Three days later reduction in the number and extent of intra-axial lesions above and infratentorial.
Results The clinical and resonancia were doing suspect herpes virus encephalopathy, so income at the start of treatment with intravenous acyclovir. When we receive negative results and the improvement of symptoms, treatment it was suspended treatment with acyclovir on the fifteenth day and start treating autoimmune encephalitis with five boluses of methylprednisolone one gram every 24 hours.
Conclusions The day of discharge was treated with 60 mg of prednisolone daily. the fever subsides completely within three days before discharge, and intention tremor persists discrete gait instability.