Mild encephalitis/encephalopathy with reversible splenial lesion (MERS) associated with respiratory syncytial virus and Pseudomonas putida infection: A case report

Abstract

Background: Clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a mild encephalopathy, which may be associated with various pathogens, including virus and bacteria. However, there have been no reports on MERS associated with co-infection by respiratory syncytial virus (RSV) or Pseudomonas putida in adults. Case presentation: We reported a 29-year-old Chinese woman with MERS associated with RSV and Pseudomonas putida. This woman presented with fever, sore throat, cough, and altered mental states. The results of RSV-RNA in the specimens from throat and sputum culture of Pseudomonas putida were positive. The initial head CT scan on the day of admission revealed abnormal hypodense lesions in the suprasellar cistern (SCC). Subsequent brain magnetic resonance imaging (MRI) also demonstrated abnormal hypersignals in the same region. The patient's altered mental status improved on day after ceftriaxone and low-dose corticosteroid therapy. The SCC hypersignal on MRI completely resolved after three weeks, and no recurrence of symptoms occurred during the two-month follow-up period. Conclusions: It is the first reported case of MERS associated with RSV and Pseudomonas putida in the adult, which broadens the spectrum of potential etiologies in MERS. When a patient with a respiratory tract infection presents with neurological symptoms, the possibility of MERS should be considered.

Keywords

• Encephalitis
• Pseudomonas putida
• Respiratory syncytial virus
• Reversible splenial lesion