Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Case report of acute encephalopathy caused by enterohemorrhagic Escherichia coli infection in a 24-year-old woman

Yuya Suzuki, M.D.1), Takao Fukushima, M.D., Ph.D.1), Takahiro Iwasawa, M.D.2), Gen Nakamura, M.D., Ph.D.3), Shigeki Nanasawa, M.D.1) and Kunihiko Makino, M.D.1)

1)Department of Neurology, Niigata Prefectural Shibata Hospital
2)Department of Gastroenterology, Niigata Prefectural Shibata Hospital
3)Department of Nephrology, Niigata Prefectural Shibata Hospital

Hemolytic uremic syndrome (HUS) and acute encephalopathy caused by enterohemorrhagic Escherichia coli infection occur commonly in children, whereas adult-onset disease is rare. Here we report the case of a 24-year-old woman who developed acute encephalopathy and recovered without sequelae. She initially developed abdominal pain and diarrhea. On day 6, O-157 Shiga toxin was detected in her stool and she developed HUS. On day 11, acute encephalopathy developed and she required artificial ventilation. She was treated with steroid pulse therapy and plasma exchange (PE) and then discharged on day 53 without any sequelae. Globotriaosylceramide, a Shiga toxin receptor, is more frequently present on the cellular membranes of women than on those of men. Therefore, it is conceivable that adult women are at a higher risk of developing acute encephalopathy than men. Steroid pulse therapy and PE may effectively treat acute encephalopathy by reducing inflammatory cytokine levels in the blood; therefore, these treatments should be proactively considered.
Full Text of this Article in Japanese PDF (537K)

(CLINICA NEUROL, 59: 274|278, 2019)
key words: enterohemorrhagic Escherichia coli, acute encephalopathy, adult-onset, steroid pulse therapy, plasma exchange

(Received: 7-Mar-19)