High-dose steroid and heparin: a novel therapy for cerebral vasculitis associated with presumed group A Streptococcus meningitis
| Autor: | Katherine Muir, Julie Blackburn, Brian Alexander Hummel, Anne Pham-Huy |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Diagnostic Imaging
Mastoiditis Streptococcus pyogenes Fulminant Context (language use) Case Report Meningitis Bacterial Diagnosis Differential 03 medical and health sciences 0302 clinical medicine Prednisone 030225 pediatrics Streptococcal Infections medicine Humans Child Vasculitis Central Nervous System Stroke medicine.diagnostic_test business.industry Lumbar puncture Heparin General Medicine medicine.disease Anti-Bacterial Agents Anesthesia Drug Therapy Combination Female business Meningitis 030217 neurology & neurosurgery Cerebral vasculitis medicine.drug |
| Zdroj: | BMJ Case Rep |
| Popis: | Cerebral vasculitis is a serious complication of bacterial meningitis that can cause significant morbidity and mortality due to stroke. Currently, there are no treatment guidelines or safety and efficacy studies on the management of cerebral vasculitis in this context. Herein, we report a case of a previously well 11-year-old girl who presented with acute otitis media that progressed to mastoiditis and fulminant meningitis. Group AStreptococcuswas found in blood and ear-fluid cultures (lumbar puncture was unsuccessful). Her decreased level of consciousness persisted despite appropriate antimicrobial treatment, and repeat MRI revealed extensive large vessel cerebral vasculitis. Based on expert opinion and a presumed inflammatory mechanism, her cerebral vasculitis was treated with 7 days of pulse intravenous methylprednisolone followed by oral prednisone taper. She was also treated with intravenous heparin. Following these therapies, she improved clinically and radiographically with no adverse events. She continues to undergo rehabilitation with improvement. |
| Databáze: | OpenAIRE |
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