SHM Converge Scientific Abstract ePoster Gallery-An Atypical Presentation of Pyelonephritis: Mild Encephalopathy With Reversible Splenial Lesions (Mers)

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This case describes an 8-year-old previously healthy boy who presented with 2 days of headache, vomiting, high fever, and waxing/waning mental status with incoherent speech. Initial head CT, chest X-ray, CSF studies, and meningitis-encephalitis testing were unrevealing, and he was empirically started on ceftriaxone. Brain MRI, however, showed a lesion in the corpus callosum consistent with a reversible splenial lesion. Because he also developed abdominal pain, abdominal ultrasound was obtained and revealed left pyelonephritis.<br /><br />He was diagnosed with Mild Encephalopathy with Reversible Splenial Lesions (MERS), a radiologic-clinical syndrome characterized by transient MRI lesions in the splenium of the corpus callosum and neurologic symptoms such as headache, delirium, abnormal speech, and seizures. MERS is often associated with viral infections but can also occur with bacterial illness. Its exact mechanism is unclear, though a cytokine-mediated cytotoxic edema has been proposed.<br /><br />The patient improved clinically on antibiotics, though fevers persisted and a developing renal abscess was later identified. He was discharged on a 3-week course of cephalexin, and all symptoms had resolved by 2-week infectious disease follow-up.<br /><br />This case is notable because delirium and fever were the initial presenting symptoms, without classic urinary complaints such as dysuria or frequency. It highlights that MERS may be an early manifestation of extra-neurologic infections, including pyelonephritis, and should be considered in children with fever and neurologic symptoms when meningitis or encephalitis workup is negative.

Asset Subtitle

Meenu Krishnasamy

Meta Tag

Author List Khoa Luong, Meenu Krishnasamy, Nadia Majid

Category Clinical Vignettes

Concept Reversible Splenial Lesion Syndrome

Concept Corpus Callosum

Concept Restricted Diffusion

Concept Neurologic Symptoms

Concept Magnetic Resonance Imaging

Distinguished Non-Finalist

Presenter Organization Inova Children's Hospital

Presenting Author Meenu Krishnasamy

Track Pediatric

Keywords

MERS

reversible splenial lesion

corpus callosum

pyelonephritis

delirium

fever

pediatric encephalopathy

MRI brain

renal abscess

cephalexin

Reversible Splenial Lesion Syndrome

Corpus Callosum

Restricted Diffusion

Neurologic Symptoms

Magnetic Resonance Imaging