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Persisting vasculitis after pneumococcal meningitis

Pugin, Deborah ; Copin, Jean-Christophe ; Goodyear, Marie-Christelle ; Landis, Theodor ; Gasche, Yvan

In: Neurocritical Care, 2006, vol. 4, no. 3, p. 237-240

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    Titel
    • Persisting vasculitis after pneumococcal meningitis
    Autor
    • Pugin, Deborah. Department of Clinical Neuroscience and Dermatology, Geneva University Hospital, CH-1211, Geneva, Switzerland
    • Copin, Jean-Christophe. Department of Fundamental Neurosciences, Geneva University Hospital, CH-1211, Geneva, Switzerland
    • Goodyear, Marie-Christelle. Department of Fundamental Neurosciences, Geneva University Hospital, CH-1211, Geneva, Switzerland
    • Landis, Theodor. Department of Clinical Neuroscience and Dermatology, Geneva University Hospital, CH-1211, Geneva, Switzerland
    • Gasche, Yvan. Department of Fundamental Neurosciences, Geneva University Hospital, CH-1211, Geneva, Switzerland
    Dokumententyp
    • Postprint
    Sprache
    • Englisch
    Veröffentlicht in
    • Neurocritical Care, 2006, vol. 4, no. 3, p. 237-240. Humana Press
    Andere elektronische Ausgabe
    OAI-PMH-ID
    • oai:doc.rero.ch:320518
    Summary
    Introduction: Bacterial meningitis is associated with a high mortality and a high incidence of neurological sequelae. Parainfectious vasculitis leading to ischemic brain damage is a known complication of bacterial meningitis but its treatment is uncertain. Methods and Results: We report the case of a 53-year-old man with pneumococcal meningitis who developed numerous ischemic lesions in the brainstem and basal ganglia caused by parainfectious vasculitis. Clinical and radiological improvement was observed after delayed corticosteroid initiation. Symptomatic vasculitis relapsed after steroid withdrawal and stabilized after reintroduction of the immunosuppressive therapy. Although the cerebrospinal fluid (CSF) contained high levels of MMP-9 at the time of symptomatic vasculitis, a significant decrease of the enzyme accompanied the introduction of corticotherapy and the regression of vasculitic symptoms. No relation between the level of MMP-9 and the white blood cell count in CSF could be found. Conclusion: Parainfectious vasculitis may respond to late corticosteroid treatment. MMP-9 level in CSF may be a marker of vasculitic complication in bacterial meningitis