Images in… BMJ Case Reports: first published as 10.1136/bcr-2015-211761 on 20 July 2015. Downloaded from Longitudinally extensive transverse myelitis and meningitis due to a rare infectious cause Diana Moreira Amaral,1 Tiago Parreira,2 Mafalda Sampaio3 1Hospital Pediátrico Integrado DESCRIPTION scan was performed, showing no abnormalities. — Centro Hospitalar São João, A previously healthy 9-year-old girl was admitted Focal and generalised seizures started by the ninth Porto, Portugal 2Serviço de Neurorradiologia, to the emergency department of a district hospital day of disease, followed by right-sided Todd hemi- Centro Hospitalar de São João, due to persistent headache for 3 days. Somnolence, paresis. A second lumbar puncture showed Porto, Portugal fever and meningismus were noticed. No previous increased pleocytosis (316 cells, 66% of lympho- 3 Unidade de Neuropediatria, infections or recent immunisations were reported. cytes). Acyclovir and vancomycin were added and Hospital Pediátrico Integrado — The child had leucocytosis with elevated C reactive the patient was transferred to our hospital with the Centro Hospitalar São João, fl Porto, Portugal protein. Cerebrospinal uid (CSF) analysis showed diagnostic hypothesis of meningoencephalitis. On pleocytosis of 96 cells, 73% of lymphocytes, with admission, she presented a normal level of con- Correspondence to negative bacteriological, enterovirus and herpes sciousness, and the physical examination showed Dr Diana Moreira Amaral, simplex virus screen. Ceftriaxone was started. flaccid paraparesis, pain and vibratory hypoesthesia
[email protected] Owing to persistent fever and headache, a brain CT below T2 and bilateral cervical adenopathy. Accepted 8 July 2015 Ciprofloxacin was added. Brain MRI revealed leptomeningeal enhancement with no basal ganglia or thalami involvement.