Dados do Trabalho

Título

CHILDHOOD ENCEPHALITIS: A CHALLENGING DIAGNOSIS.

Apresentação do caso

A 16-year-old male patient, residing in the United States, on vacation to Brazil, with a history of attention deficit hyperactivity disorder, without other comorbidities, seeks the emergency with headache and vomiting for 3 days, evolving with headache worsening, sensorium and speech alteration. In the initial evaluation, he had labial commissure deviation and altered level of consciousness (Glasgow 14). Cranial CT was performed for suspected stroke, which was normal. Investigation progressed with lumbar puncture and laboratory tests, and CSF showed pleocytosis (142 leukocytes/mm³, lymphocytes 86% and monocytes 14%) and increased protein (134 mg/dl). The patient evolved with sensorium oscillation and was referred to the ICU for monitoring. The electroencephalogram showed severe diffuse encephalopathy with greater involvement of both temporal regions. A diagnostic hypothesis of viral encephalitis was made and acyclovir was started empirically. An extensive etiological investigation was carried out, with collection of serology and molecular panel, which were negative for herpesvirus in cerebral spine fluid and serology. However, the search for neutralizing antibodies for Coxsaquie virus B type 4 and 5 was positive at high titers (1/512 and 1/128), indicating active infection, thus confirming the hypothesis of Coxsaquie meningoencephalitis.

Discussão

Enteroviruses are one of the main etiologic agents of acute encephalitis in children, accounting for about 5% of cases. Among the enteroviruses, coxsackievirus types A9, B2 and B5 and echovirus types 6 and 9 are the most frequently reported serotypes. Clinical manifestations are indistinguishable from other causes of acute encephalitis, although enterovirus encephalitis is associated with less severe illness, shorter hospitalization, and better outcomes compared to other viral agents. In our country, the identification of this etiologic agent is uncommon in view of the difficulty in accessing diagnostic tests.

Comentários finais

Viral encephalitis is a prevalent disease and an important cause of acute sensorium alteration. In most cases, the etiology remains unknown despite extensive evaluation. In cases where it is possible to identify the agent, enteroviruses, especially coxsackievirus, stand out as an important agent. In this case described, the patient did not present other clinical manifestations of infectious coxsackie disease and the etiological identification was possible based on the search for neutralizing antibodies.

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