Canan KUZDAN, Bahar ERBAŞ, Ahmet SOYSAL, Yüksel YILMAZ, Nilüfer HACIFAZLIOĞLU ELDEŞ

Mycoplasma pneumonia’ya Bağlı Akut Serebellar Ataksi: İki Vaka Sunumu

Sinir sistemi, solunum sistemi dışında Mycoplasma pneumonia infeksiyonundan en sık etkilenen sistemdir. Akut serebellar ataksi ile başvuran ve serolojik olarak M. pneumonia pozitifliği gösterilen iki vaka sunulmuştur. Altı yaşında kız hasta ani başlayan yürümede dengesizlik, 7 yaşındaki diğer hasta 4 gündür devam eden bulantıkusma ve halsizlik yakınması ile başvurdular. Her iki hastanın da nörolojik muayenelerinde ataksi ve serebellar bulgular saptandı. Rutin hemogram, biyokimya, kranyal Manyetik Rezonans Görüntüleme MRG , Beyin Omur İlik Sıvısı BOS incelemesi, BOS ve serum mikrobiyolojik incelemeleri normal bulundu. M.pneumonia serum IgM ve IgG pozitif saptandı. Klaritromisin tedavisi başlanan hastalarda ilkinde tedavinin 2. gününden itibaren, ikinci hastada ise 3. günden sonra serebellar bulguları düzelmeye başladı ve kayboldu. Başka nedene bağlanamayan akut serebellar ataksi ile başvuran çocuklarda M.pneumonia sorumlu olabilir ve antibiyoterapi ile nörolojik belirti ve bulgular hızla gerileyebilir.

Anahtar Kelimeler:

Ataksi, Mycoplasma pneumonia

Acute Cerebellar Ataxia Associated with Mycoplasma pneumonia Infection

Nervous system is the most frequently affected system by Mycoplasma pneumoniae infections other than respiratory system two patients who were admitted with acute cerebellar ataxia and whose serological tests were positive for Mycoplasma pneumoniae are reported. A 6-year-old girl with acute ataxia and cerebellar symptoms and the other, seven-year-old girl suffering from nausea, vomiting and fatigue for 4 days were admitted to our hospital. Ataxia and cerebellar symptoms were found during their neurologic examination. Results of routine hematologic, and biochemical tests, cranial Magnetic Resonance Imaging MRI , Cerebrospinal fluid CSF , and serum microbiological analyses were within normal limits, but M. pneumonia IgM and IgG positivities were detected. Clarithromycine treatment was initiated, and cerebellar symptoms were resolved on the second day of therapy in the first patient and third day in the second patient. M.pneumonia can be responsible for acute cerebellar ataxia of otherwise unexplained origin. Besides, neurologic symptoms may improve with antibiotherapy

Keywords:

Ataxia, Mycoplasma pneumonia,

PDF

___

1. Kim SM, Heo JS, Shim EJ, LeeDH, Cho BJ, Kim DH, et al. Two cases of central nervus system complication caused by Mycoplasma pneumonia infection. Korean Journal of Pediatrics 2008;51(5):533-7. http://dx.doi.org/10.3345/kjp.2008.51.5.533
2. Keegan BM, Lowry NJ, Yager JY. Mycoplasma pneumoniae: a cause of coma in the absence of meningoencephalitis. Pediatr Neurol 1999;21(5):822-5. http://dx.doi.org/10.1016/S0887-8994(99)00087-9
3. Steer AC, Starr M, Kornberg A. Ickerstaff brainstem encephalitis associated with Mycoplasma pneumonia infection. J Child Neurol 2006;21:533-4. PMid:16948943
4. Twomey JA, Espir ML. Neurological manifestations and Mycoplasma pneumonia infection. Br Med J 1979;2:832-3. http://dx.doi.org/10.1136/bmj.2.6194.832 PMid:509118 PMCid:1596663
5. Lerer R, Kavasky SM. Central nervous system disease associated with Mycoplasma pneumonia infection. Pediatrics 1973;52:658-68. PMid:4598176
6. Nussinovitch M, Prais D, Volovitz B, Shapiro R, Amir J. Post-infectious acute cerebellar ataxia in children. Clin Pediatr 2003;42(7):581-4. http://dx.doi.org/10.1177/000992280304200702 PMid:14552515
7. Tsiodras S, Kelesidis I, Kelesidis T, et al. Central nervous system manifestations of Mycoplasma pneumonia infections. J Infect 2005;51:343-54. http://dx.doi.org/10.1016/j.jinf.2005.07.005 PMid:16181677
8. Komatsu H, Kuroki S, Shimizu Y, et al. Mycoplasma pneumonia meningoencephalitis and cerebellitis with aniganglioside antibodies. Pediatr Neurol 1998;18(2):160-4. http://dx.doi.org/10.1016/S0887-8994(97)00138-0
9. Kasahara I, Otsub Y, Yanase T, et al. Isolation and charactrization of Mycoplasma pneumonia from cerebrospinal fluid of a patient with meningoencephalitis. J Infect Dis 1985;152: 823-5. http://dx.doi.org/10.1093/infdis/152.4.823 PMid:3930621