ABSTRACT
A 34-year-old man developed fever and headache, followed by finger tremor and gait disturbance, and was admitted to our hospital about two months after onset. Blood tests showed a white blood cell count of 32,600 /µL with an eosinophil count of 22,300 /µL. There was no evidence of allergic drug reaction or parasitic infection. Cerebrospinal fluid examination demonstrated mononuclear pleocytosis without eosinophils or atypical cells. Brain MRI showed symmetric lesions bilaterally in the medial temporal lobe, frontobasal and insular regions and medulla oblongata. Herpes simplex virus-DNA was negative in the cerebrospinal fluid. The patient died about four months after onset. Histopathologically, there was infiltration of T cells, B cells and macrophages throughout the whole brain, but eosinophils or atypical cells were absent. Immunohistochemistry for herpes simplex virus type 1 and human herpesvirus 6 was negative. This case suggests that fatal encephalitis may develop in association with hypereosinophilic syndrome.
Subject(s)
Encephalitis/diagnosis , Encephalitis/pathology , Hypereosinophilic Syndrome/complications , Adult , Autopsy , Encephalitis/etiology , Fatal Outcome , Humans , Magnetic Resonance Imaging , MaleSubject(s)
Cerebral Hemorrhage/psychology , Paralysis/psychology , Thalamus/blood supply , Aged , Female , HumansABSTRACT
We present, to the best of our knowledge, the first case of listeria meningitis with increased adenosine deaminase (ADA) in cerebrospinal fluid. Although some cases of other etiologies were also reported, this report informs those who manage patients with meningitis that not only Mycobacterium and Brucella spp. but also other facultative agents can increase ADA levels in cerebrospinal fluid, possibly through monocyte-macrophage activation.
