A 4-year-old girl with clinically mild encephalopathy with a reversible splenial lesion associated with rotavirus infection.

Rotavirus is a common cause of severe gastroenteritis in children. It is known that rotavirus gastroenteritis may be accompanied by neurological manifestations, including encephalitis/encephalopathy and seizures. We report a case of a 4-year-old girl with clinically mild encephalopathy with a reversible splenial lesion associated with rotavirus infection. She was admitted to our hospital because of reduced level of consciousness, seizures, diarrhea, and vomiting. Fecal rotavirus antigen testing was positive. Cell counts in the cerebrospinal fluid (CSF) were normal. She had a normal serum sodium level on admission. Brain computed tomography showed no cerebral edema. However, electroencephalography showed generalized high-voltage slow waves, and diffusion-weighted magnetic resonance imaging demonstrated a transient abnormality in the splenium of the corpus callosum. We diagnosed clinically mild encephalopathy with a reversible splenial lesion associated with rotavirus infection. She recovered well and exhibited no neurological sequelae. Rotavirus RNA and antigen were not detected in the CSF, suggesting that the reversible splenial change was caused by indirect effects on the central nervous system subsequent to viral infection. Her normal serum sodium level indicates that this change can occur without hyponatremia.

A 7-year-old girl with subcutaneous emphysema, pneumomediastinum, pneumothorax, and pneumoretroperitoneum caused by Mycoplasma pneumoniae pneumonia.

A 7-year-old girl presented with subcutaneous emphysema, pneumomediastinum (PM), pneumoretroperitoneum, and pneumothorax caused by Mycoplasma pneumoniae (MP). The patient had been treated with clarithromycin for pneumonia at another hospital; however, her condition deteriorated and complications developed. Soon after admission to our hospital, we started the patient on minocycline and prednisolone, and the complications improved promptly. Laboratory data showed serum ferritin and urinary beta-2-microglobulin levels were greatly elevated. We therefore speculated that the patient might have underlying hypercytokinemia. Prednisolone is an effective treatment for hypercytokinemia. We therefore recommend prednisolone treatment for cases of severe M. pneumoniae pneumonia that do not respond to antimicrobial agents.

Increased urinary hydrogen peroxide levels caused by coffee drinking.

Experiments with volunteers in Singapore have demonstrated that coffee drinking increases urinary hydrogen peroxide levels (Long, Halliwell, Free Rad. Res., 32, 463-467 (2000)). We re-examined the effect of coffee drinking of healthy Japanese subjects on urinary hydrogen peroxide levels. A cup of brewed or canned coffee commercially available in Japan generated 120-420 micro mol hydrogen peroxide in incubation in a neutral medium at 37 degrees C for 6 h. The increased levels were higher than those obtained from a cup of green tea extract or a glass of red wine. After the subject drank a cup of coffee, apparent hydrogen peroxide levels (micro mol/g creatinine) in urine collected 1-2 h after coffee drinking increased 3-10-fold compared to the levels before coffee drinking. The increased urinary hydrogen peroxide levels are likely derived mainly from 1,2,4-benzenetriol excreted in urine, because the major component that generates hydrogen peroxide is found to be 1,2,4-benzenetriol, and storing urine collected after coffee drinking increased hydrogen peroxide levels in a time-dependent fashion. Total hydrogen peroxide equivalent levels excreted in 3 h-urine after coffee drinking were estimated to be 0.5-10% that of coffee consumed. A residual amount of hydrogen peroxide may be retained or consumed in human bodies.