No abstract

A previously neurodevelopmentally intact 5-year-old male was admitted to hospital with a right lower lobe pneumonia with pleural effusion, subsequently confirmed to be a Mycoplasma pneumoniae infection. On the seventh day of the illness he had a prolonged generalized tonic or tonic-clonic convulsion, requiring intubation and ventilation. He was slow to regain consciousness (Child's Glasgow Coma Score 7-10 over 6 days) and brain imaging with CT and then MRI demonstrated bilateral thalamic lesions with oedema and central haemorrhage suggestive of acute bilateral thalamic necrosis, without striatal or white-matter involvement. He was treated with a 2-week course of erythromycin, and as an autoimmune process was considered possible, 5 days of intravenous methylprednisolone (20 mg/kg/day) followed by a 4-week oral prednisolone taper. He made a slow recovery over the next few weeks with almost complete neurological recovery by 2 months but with significant dysarthria, drooling, and a mild left hemiparesis. At 9 months, significant dystonia continued to affect his speech and, together with tremor, his upper-limb fine motor function bilaterally. His gait, personality, and higher cognitive functions appeared to have recovered fully. Although acute striatal necrosis, acute disseminated encephalomyelitis, and encephalitis have been reported with Mycoplasma pneumoniae and a similar picture of acute bilateral thalamic necrosis with influenza-A ('acute necrotizing encephalopathy'), this is the first reported case of Mycoplasma pneumoniae-associated isolated acute bilateral thalamic necrosis.

A previously neurodevelopmentally intact 5–year‐old male was admitted to hospital with a right lower lobe pneumonia with pleural effusion, subsequently confirmed to be a Mycoplasma pneumoniae infection. On the seventh day of the illness he had a prolonged generalized tonic or tonic‐clonic convulsion, requiring intubation and ventilation. He was slow to regain consciousness (Child's Glasgow Coma Score 7–10 over 6 days) and brain imaging with CT and then MRI demonstrated bilateral thalamic lesions with oedema and central haemorrhage suggestive of acute bilateral thalamic necrosis, without striatal or white‐matter involvement. He was treated with a 2–week course of erythromycin, and as an autoimmune process was considered possible, 5 days of intravenous methylprednisolone (20mg/kg/day) followed by a 4–week oral prednisolone taper. He made a slow recovery over the next few weeks with almost complete neurological recovery by 2 months but with significant dysarthria, drooling, and a mild left hemiparesis. At 9 months, significant dystonia continued to affect his speech and, together with tremor, his upper‐limb fine motor function bilaterally. His gait, personality, and higher cognitive functions appeared to have recovered fully. Although acute striatal necrosis, acute disseminated encephalomyelitis, and encephalitis have been reported with Mycoplasma pneumoniae and a similar picture of acute bilateral thalamic necrosis with influenza‐A (‘acute necrotizing encephalopathy’), this is the first reported case of Mycoplasma pneumoniae‐associated isolated acute bilateral thalamic necrosis.

No abstract

PurposeRheumatic fever (RF) is uncommon in the UK. The reported incidence in wealthy countries is below 1/100,000. This study aimed to identify how RF presents in South Wales, and to see if patients were diagnosed appropriately and received the correct investigations and treatment.MethodsRetrospective study of all paediatric patients with first presentation of RF in South Wales between 1 st January 2004- 30th April 2017. The Revised Jones Criteria 2015 were used to diagnose RF.ResultsA total of 35 patients met all inclusion criteria, with an estimated incidence of 0.81/100,000 5–14 year olds in South Wales. 28/35 patients presented with carditis, in whom 9 of the carditis was silent and was diagnosed from echocardiographic features. 19/35 patients presented with chorea, 12/35 with arthritis, 4/35 with erythema marginatum and 2/35 with subcutaneous nodules. Only 17/35 patients had a throat swab performed compared to 34/35 who had an ASOT or AntiDNase B titre performed. 6/35 patients had no initial eradication Penicillin treatment, but all 35 patients were on correct secondary prophylaxis.ConclusionAlthough the condition has undergone a decline in the UK, there are still estimated 3 presentations of RF a year in South Wales. Chorea and carditis were the most prominent presenting features, although in many the carditis was clinically silent and was diagnosed by echocardiography. Clinicians still need to be aware of this condition and its treatment, as many patients are not receiving the correct investigations or initial eradication therapy.