ro13-9904 and Lymphocytosis

BACKGROUND Acute cerebellitis in adults is a rare disease. The etiology is unknown but postulated to be due to primary infection or para-infection. Different presentations have been reported, which complicates the diagnosis process. CASE REPORT We report the case of a young man who presented with headache, vomiting, and vertigo. He was found to have ataxia and cerebellar signs, bradycardia magnetic resonance imaging (MRI) of the brain showed acute cerebellitis, and cerebrospinal fluid (CSF) studies showed lymphocytosis. Further investigations showed the presence of Epstein-Barr virus (EBV) immunoglobulin M (IgM) and IgG. His symptoms resolved completely with corticosteroid and antiviral treatments. CONCLUSIONS Acute cerebellitis can present in various ways. Bradycardia, along with neurological deficits, should raise the suspicion of acute cerebellitis.

Topics: Acute Disease; Acyclovir; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antiviral Agents; Ataxia; Bradycardia; Ceftriaxone; Cerebellar Diseases; Dexamethasone; Epstein-Barr Virus Infections; Glucocorticoids; Humans; Immunoglobulin G; Immunoglobulin M; Lymphocytosis; Male; Young Adult

A 13-year-old boy who presented with a red left eye, painful eye movement, blurred vision, photophobia and increased lacrimation, was diagnosed with 1-sided panuveitis with optic disk edema. Diagnostic work-up revealed borrelial antibodies in serum. Diagnosis of Lyme borreliosis was substantiated by demonstration of lymphocytic pleocytosis, intrathecal borrelial antibody synthesis, improvement after treatment with ceftriaxone and exclusion of other causes.

Topics: Adolescent; Anti-Bacterial Agents; Antibodies, Bacterial; Borrelia burgdorferi Group; Ceftriaxone; Humans; Lyme Disease; Lymphocytosis; Male; Panuveitis; Treatment Outcome

HaNDL (transient headache and neurological deficits with cerebrospinal fluid lymphocytosis) syndrome is an infrequent condition included at group 7 "headache attributed to non-vascular intracranial disorder" in the recent International Classification of Headache Disorders (ICHD-3), code 7.3.5. The description states "migraine-like headache episodes (typically 1-12) accompanied by neurological deficits including hemiparaesthesia, hemiparesis and/or dysphasia, but positive visual symptoms only uncommonly, lasting several hours. There is lymphocytic pleocytosis. The disorder resolves spontaneously within 3 months". In this description confusional state is not considered as a main symptom, even if in the literature this aspect is frequently reported. Here, we report the cases of two young boys presenting with confusional state as the main complaint. The possible pathogenesis of the different clinical presentation is discussed.

Topics: Acyclovir; Adolescent; Ceftriaxone; Confusion; Headache; Humans; Lymphocytosis; Male; Nervous System Diseases; Young Adult

We report the case of a 76-year old woman, who presented with signs of a meningoencephalitis. The result of lumbar puncture showed a mononuclear pleocytosis. Empirical antimicrobial treatment was promptly initiated. Nevertheless a comatose state complicated the clinical course. The diagnosis of neuroborreliosis was made serologically and by molecular biology. Under adequate therapy with intravenous ceftriaxone the patient showed a slow but full recovery. This case illustrates that potentially reversible diseases need very careful decision making regarding therapeutic activities and that neuroborreliosis is a potentially reversible cause of severe neurologic impairment.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Coma; Diagnosis, Differential; Female; Humans; Infusions, Intravenous; Lyme Neuroborreliosis; Lymphocytosis; Meningitis; Tomography, X-Ray Computed

We report a case in a 50-year-old male who had been treated with ceftriaxone for 3 weeks to treat meningitis. He was admitted 4 days after cessation of the ceftriaxone treatment with fever, headache, nausea, vomiting, myalgia, arthralgia, pruriginous skin rashes, and with edema on face. Blood tests showed marked eosinophilia and atypic lymphocytosis. He was successfully treated with prednisone p.o. We report this case as we could not recognize a case like this which was induced by ceftriaxone.

Topics: Anti-Bacterial Agents; Ceftriaxone; Drug Eruptions; Drug Hypersensitivity; Eosinophilia; Fever; Humans; Lymphocytosis; Male; Middle Aged; Prednisone