[Highly beneficial outcome in a case of acute hemorrhagic leukoencephalitis (Hurst's encephalitis) treated with methylprednisolone pulse therapy and continuous hemodiafiltration].

Abstract

The patient was a male in his 30s, under treatment for Crohn's disease of the small intestine since his 20s. He was admitted to the hospital due to worsening renal function. Two days after admission, he suddenly developed left upper and lower extremity paralysis followed by generalized convulsions and decreased level of consciousness. Head MRI showed multiple abnormal signal areas in the bilateral cerebral white matter and multiple microhemorrhages inside the lesions. CSF examination showed 11,136 cells/mm³ (98% polymorphonuclear cells, 2% mononuclear cells), 311 ‍mg/dl protein, 76 ‍mg/dl sugar, and MBP > 2,000 pg/ml. Chest X-ray showed infiltrate and multiple nodular shadows in both lung fields, and venous blood culture detected Staphylococcus epidermidis. Her general condition and neurological symptoms gradually improved after continuation of antimicrobial agents, methylprednisolone pulse therapy, and continuous hemodiafiltration. Acute hemorrhagic leukoencephalitis is a type of severe acute disseminated encephalomyelitis, and cases of marked improvement such as the present case are rare. We report this case with some discussion.