Progressive quadriparesis and inflammation: A common disease, a rare presentation.

A previously healthy, 10-years-old girl presented with progressively worsening pain and weakness of the limbs for the past 2 weeks. It initially started with low-grade fever lasting for 4 days followed by severe pain over bilateral lower and upper limbs. Gradually she became bed-ridden. On examination, she had severe neck rigidity, generalized tenderness all over the body, generalized hyperalgesia, hyporeflexia, bilateral extensor plantar response and toe-walking. An initial clinical diagnosis of Landry-Guillain Barry syndrome was considered. Nerve conduction study showed generalized, demyelinating polyneuropathy. She was administered IVIG and was evaluated for other causes of arachnoiditis. MRI brain and spine showed enhancement and clumping of nerve roots in the conus and cauda equina. CECT chest showed necrotic mediastinal lymphnodes. A final diagnosis of disseminated tuberculosis with tuberculous arachnoiditis was considered and she was administered ATT, pulse methylprednisolone followed by maintenance oral corticosteroids. Currently, after 5 months of therapy, she has recovered clinically.

COVID-19 Associated Multisystem Inflammatory Syndrome: A Systematic Review and Meta-analysis.

The prevalence of multisystem inflammatory syndrome in children (MIS-C) has increased since the coronavirus disease 2019 (COVID-19) pandemic started. This study was aimed to describe clinical manifestation and outcomes of MIS-C associated with COVID-19. This systematic review and meta-analysis were conducted on all available literature until July 3rd, 2020. The screening was done by using the following keywords: ("novel coronavirus" Or COVID-19 or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or coronavirus) and ("MIS-C" or "multisystem inflammatory" or Kawasaki). Data on gender, ethnicity, clinical presentations, need for mechanical ventilation or admission to intensive care unit (ICU), imaging, cardiac complications, and COVID-19 laboratory results were extracted to measure the pooled estimates. Out of 314 found articles, 16 articles with a total of 600 patients were included in the study, the most common presentation was fever (97%), followed by gastrointestinal symptoms (80%), and skin rashes (60%) as well as shock (55%), conjunctivitis (54%), and respiratory symptoms (39%). Less common presentations were neurologic problems (33%), and skin desquamation (30%), MIS-C was slightly more prevalent in males (53.7%) compared to females (46.3%). The findings of this meta-analysis on current evidence found that the common clinical presentations of COVID-19 associated MIS-C include a combination of fever and mucocutaneous involvements, similar to atypical Kawasaki disease, and multiple organ dysfunction. Due to the relatively higher morbidity and mortality rate, it is very important to diagnose this condition promptly.

Clinical and biochemical differences between hantavirus infection and leptospirosis: a retrospective analysis of a patient series in Belgium.

Objectives: Hantavirus infection and leptospirosis are infectious diseases transmitted by rodents. The clinical picture is nonspecific, often involving the kidneys but other organs can be affected too. Clinical and biochemical clues to make a difference between these two entities will be described.Methods: A retrospective analysis was performed on a database of patients presenting between January 2012 and September 2017 at the emergency department of the university hospital Leuven, Belgium. Patients were selected on the basis of a compatible clinical picture, biochemistry, and microbiological evidence. Presenting complaints and clinical examination were compared. Blood, taken at presentation, was used for hematological and biochemical analysis.Results: Sixteen patients with hantavirus infection and eight patients with leptospirosis were identified. All patients complained about general malaise and fever. Other frequent complaints were myalgia and a headache. Patients with leptospirosis often experienced photo- or sonophobia.Looking for neck stiffness and eye lesions might help to diagnose leptospirosis.Differences in biochemistry between viral and bacterial disease could be recognized; high C-reactive protein (CRP) and leukocytosis with left shift favor leptospirosis, elevated lactate dehydrogenase (LDH) favors viral infection. Abnormal liver function with raised total bilirubin is often seen in cases with leptospirosis.Conclusion: This study demonstrates some subtle clues that may help to differentiate between hantavirus infection and leptospirosis in patients presenting to a hospital in a nonendemic region of the world. Because of small number of patients, we could not identify significant clinical or biochemical tests. Serology remains the gold standard.

Meningite asséptica / Aseptic meningitis

JUSTIFICATIVA E OBJETIVOS: As meningites assépticas (MA) representam a grande maioria das meningites presentes em nosso meio. Os principais causadores dessa doença são os enterovírus. O quadro clínico caracteriza-se por cefaleia, fotofobia, sinais de irritação meníngea, náuseas, vômitos e febre. A grande dificuldade diagnóstica é que estes mesmos sintomas são encontrados nos quadros de meningites bacterianas, mais graves, demandando condutas mais agressivas. O objetivo deste estudo foi rever o assunto, destacando o manuseio dos casos suspeitos bem como suas etiologias e fisiopatologias. CONTEÚDO: Conceitos de MA, suas etiologias virais e não virais, incluindo àquelas causadas pela utilização de medicamentos. CONCLUSÃO: Devido às sobreposições sintomatológicas, introduziu-se empiricamente a antibioticoterapia intra-hospitalar no momento da suspeita de infecção meníngea, observando a evolução clínico-laboratorial do paciente.

BACKGROUND AND OBJECTIVES: The aseptic meningitis (AM) representing the vast majority of meningitis in our society. The main cause of this disease is the enteroviruses. The clinical picture is characterized by headache, photophobia, and signs of meningeal irritation, nausea, vomiting and fever. The diagnostic difficulty is that these same symptoms are found in the tables of bacterial meningitis, the most serious, demanding more aggressive treatment. This article aims to review the issue, emphasizing the management of suspected cases as well as its etiology and pathophysiology. CONTENTS: Address the concept of AM, its viral and nonviral etiologies, including those caused by medication use. CONCLUSION: Due to the overlap of the symptoms, we introduced an empirical intrahospital antibiotic treatment at the moment we suspect meningeal infection, observing the evolution of clinical and laboratory signs.

Tripod sign.

"Tripod Sign" or "Amoss's Sign" is a sign of meningeal irritation. Although useful in diagnosing meningitis, it is not pathognomic and may be seen in a variety of clinical conditions. Infants < 1 year of age and immunocompromised individuals may not demonstrate signs of meningeal irritation. Since elicitation of the sign requires voluntary sitting up, it is of limited use in patients with marked altered sensorium and young infants.

The frequency of physical signs usually attributed to meningeal irritation in elderly patients.

Nuchal rigidity, which may be a sign of meningitis, was found in 35 per cent of geriatric patients on acute-care and rehabilitation wards and in 13 per cent of younger patients on an acute-care ward. It was significantly associated with cerebrovascular disease, confusion, abnormal plantar responses, and primitive reflexes. Elderly patients who have nuchal rigidity with no history of neurologic or cognitive disorders should be investigated for meningitis.

Acute monocular visual loss secondary to anterior communicating artery aneurysm in a patient with sickle cell disease.

A patient with sickle cell disease had acute monocular visual loss with no visible vitreal or retinal abnormalities. A large aneurysm of the anterior communicating cerebral artery was found, with direct compression of the optic nerve. This represents a very rare presentation of a relatively common lesion. Consideration should always be given to compressive lesions as the cause of acute monocular visual loss in the absence of visible vitreal, retinal, or optic nerve disease.