Infección por Bartonella henselae con compromiso de sistema nervioso central, asociado a un papiloma del plexo coroídeo / Central nervous system infection by Bartonella henselae associated with a choroid plexus papilloma

Resumen La infección por Bartonella henselae es una enfermedad prevalente en nuestro país. En general, se presenta como la enfermedad por arañazo de gato o un síndrome febril prolongado. Existen manifestaciones atípicas dentro de las cuales está el compromiso óseo, cardíaco, hepatoesplénico y del sistema nervioso central. Se presenta el caso de una adolescente con historia de vómitos, fiebre y ataxia, en que se diagnosticó una infección por Bartonella henselae con compromiso del sistema nervioso central, asociada a un papiloma del plexo coroídeo. Este caso corresponde a una presentación inusual, de difícil diagnóstico. Su tratamiento es motivo de controversia, tanto en si es necesario tratar, la elección del antimicrobiano, como su duración.

Bartonella henselae infection is a prevalent illness in Chile. It presents generally as a cat scratch disease or as a prolonged fever syndrome. There are atypical manifestations, which include central nervous system, bone, cardiac and hepato-esplenic compromised. We present an adolescent case with a history of fever, vomiting and ataxia, whose diagnosis was a central nervous system infection by Bartonella henselae associated with a choroid plexus papilloma. This case corresponds to an unusual presentation, with a challenging diagnosis. It is controversial whether to treat this patient, which antimicrobial is the right choice and how long the treatment should be.

Adult choroid plexus papilloma: cause of sudden death.

Choroid plexus papilloma (CPP) is a rare, benign neoplasm, relatively more common in childhood. It is associated with signs and symptoms of increased intracranial pressure, frequently in association with obstructive hydrocephalus. CT and MRI are the investigations of choice and are diagnostic. Sudden deaths have been reported, but are very unusual. A 41 year old male was brought for medico-legal autopsy examination on ground of sudden death. He was reported to have headaches over a long period of time. On autopsy examination, massive sub-arachnoid hemorrhage was seen on both the cerebral hemispheres and cerebellum. A cyst measuring about 1 cm diameter was found in choroid plexus of right lateral ventricle. On histopathological examination, it was found to be a choroid plexus papilloma. Calcification was also evident in the papilloma. From medico-legal aspect, the present case reveals an unusual cause for sudden death in an adult male. The pathology could have been diagnosed easily by CT scan or MRI. When diagnosed, it has good survival rate, the morbidity depending on the extent of pathological effects. The present case was likely to have survived having minimal effects with appropriate treatment had he been diagnosed. The pathology is rare and a suspicion for this pathology in the adult male was not expected, but a CT scan to investigate chronic headache was warranted. Absence of such a suggestion leading to death, which could have been preventable, is sufficient ground for charge of professional negligence.

Choroid plexus papilloma associated with developmental delay.

Choroid plexus papillomas are rare, benign tumors of neuroectodermal origin usually observed in the lateral ventricles of children. The usual presenting signs of choroid plexus papillomas are related to hydrocephalus and increased intracranial pressure. A child presented to us with clinical features of delayed milestones, which was later diagnosed as a case of choroid plexus papilloma with hydrocephalus. He underwent complete excision of the tumour with gradual recovery of milestones.

Choroid plexus papilloma of the posterior third ventricle during infancy & childhood: report of two cases with management morbidities.

We report two cases of posterior third ventricular choroid plexus papilloma, one in an 8-month-old infant and another in a two-year-old child. These cases presented with features of obstructive hydrocephalus. Both these patients underwent a ventriculo-peritoneal (VP) shunt surgery prior to the tumor excision. Following the VP shunt surgery both patients developed ascitis requiring exteriorization of the abdominal end of the shunt. There was a clear proof of CSF overproduction: 1400-1500 ml/day in the eight-month-old infant and 900-1200 ml/day in the two-year-old child. In the former it was transient and could be treated with revision of the VP shunt whereas in the second case a ventriculo-arterial shunt had to be done. In the second case a staged reduction cranioplasty was also performed for an enormously enlarged head (head circumference--74 cm). Interesting clinical and radiological findings and useful management strategies are described.