Case Notes
History
11 month old male with recent gastroenteritis treated with multiple antibiotics. Fever persisted along with adenoviral lymphadenitis, increasing irritability and depressed level of consciousness. An initial head MR was obtained. Over one month developed status epilepticus & HLH (hemophagocytic lymphohistiocytosis); a second MR was obtained 3 weeks later.Exam
MR susceptibility (SWI)
Prior Study
MR flair1. There are minimal changes of leptomeningeal reaction or leptomeningeal infection (possibly viral). The patient has been treated with antibiotics making CSF cultures negative. Differential includes immune overshoot response to the documented GI adenoviral infections (cytokine storm/SIRS) versus actual infectious leptomeningitis.
MR T1-w post contrast
1. Negative post contrast T1-w head MR coronal
MR diffusion
1. Regional, mainly parietal and ventral upper brain stem subpial edema and sulcal protein leak without contrast leak consistent with a humeral immune response. But, whether this represent partially treated leptomeningitis or a abnormal systemic immune response remains indeterminate.
2. Three small subcortical sites of positive MR diffusion are present consistent with cytogenic injury; basis is indeterminate.