Mild Encephalitis/Encephalopathy with Reversible Splenial Lesion (MERS) due to Cytomegalovirus: Case Report and Review of the Literature

Abstract

Mild encephalopathy with a reversible splenial lesion (MERS) is a clinico-radiological syndrome characterized by a transient mild encephalopathy and MRI findings of a reversible lesion in the splenium of corpus callosum (SCC). It is classified in MERS type I and MERS type II, depending on the involvement of SCC alone or also other white matter areas. The syndrome mainly affects children and young adults; the prognosis is favorable with complete or nearly complete neurological and radiological resolution within days or weeks. The vast majority of the cases described in the literature involve Asian and Australian children. The exact pathophysiology is unknown; however, infectious-related MERS (in particular virus associated MERS) remains the most common cause of reversible splenial lesions in childhood. To the best of our knowledge, there is only one published case of MERS associated with cytomegalovirus (CMV) infection involving an Australian child. We present here the first case of a CMV-related MERS in a European Caucasian child.

Keywords

MERS - CMV - splenial reversible lesion

• References

• 1 Chaudhuri A, Kennedy PG. Diagnosis and treatment of viral encephalitis. Postgrad Med J 2002; 78 (924) 575-583
• 2 Chen WX, Liu HS, Yang SD. , et al. Reversible splenial lesion syndrome in children: Retrospective study and summary of case series. Brain Dev 2016; 38 (10) 915-927
• 3 Fong CY, Khine MM, Peter AB, Lim WK, Rozalli FI, Rahmat K. Mild encephalitis/encephalopathy with reversible splenial lesion (MERS) due to dengue virus. J Clin Neurosci 2017; 36: 73-75
• 4 Fang Q, Chen L, Chen Q, Lin Z, Yang F. Clinically mild encephalitis/encephalopathy with a reversible splenial lesion of corpus callosum in Chinese children. Brain Dev 2017; 39 (04) 321-326
• 5 Kosami K, Kenzaka T, Sagara Y, Minami K, Matsumura M. Clinically mild encephalitis/encephalopathy with a reversible splenial lesion caused by methicillin-sensitive Staphylococcus aureus bacteremia with toxic shock syndrome: a case report. BMC Infect Dis 2016; 16: 160
• 6 Jinnai A, Kikuchi T, Ishikawa M, Nishimura Y, Shibata K, Sakura H. [A case of rubella encephalitis presenting as clinically mild encephalitis/encephalopathy with a reversible splenial lesion] [Article in Japanese]. Rinsho Shinkeigaku 2014; 54 (08) 668-670
• 7 Man BL, Fu YP. The first case of mild encephalopathy with a reversible splenial lesion due to Japanese encephalitis virus infection. BMJ Case Rep 2013; 2013: bcr2013200988
• 8 Hoshino A, Saitoh M, Oka A. , et al. Epidemiology of acute encephalopathy in Japan, with emphasis on the association of viruses and syndromes. Brain Dev 2012; 34 (05) 337-343
• 9 Ka A, Britton P, Troedson C. , et al. Mild encephalopathy with reversible splenial lesion: an important differential of encephalitis. Eur J Paediatr Neurol 2015; 19 (03) 377-382
• 10 Liptai Z, Ivády B, Barsi P, Várallyay G, Rudas G, Fogarasi A. Mild encephalitis/encephalopathy with a reversible splenial lesion in children. Ideggyogy Sz 2013; 66 (1-2): 67-71
• 11 Wang J, Stewart E, Dapaah-Afriyie K, Finn A. Mild encephalopathy with reversible splenial lesion in a patient with influenza A infection--first report in an adult patient in the USA. BMJ Case Rep 2015; 2015
• 12 Nagpal K, Agarwal P, Kumar A, Reddi R. Chikungunya infection presenting as mild encephalitis with a reversible lesion in the splenium: a case report. J Neurovirol 2017; 23 (03) 501-503
• 13 Takanashi J. Two newly proposed infectious encephalitis/encephalopathy syndromes. Brain Dev 2009; 31 (07) 521-528
• 14 Shankar B, Narayanan R, Muralitharan P, Ulaganathan B. Evaluation of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) by diffusion-weighted and diffusion tensor imaging. BMJ Case Rep 2014; 2014: bcr2014204078
• 15 Miyata R, Tanuma N, Hayashi M. , et al. Oxidative stress in patients with clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). Brain Dev 2012; 34 (02) 124-127