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BMJ Case Reports 2018; doi:10.1136/bcr-2018-224496
  • Rare disease
  • CASE REPORT

Unusual case of cerebral demyelination and bilateral optic neuritis in an infant with suppurative BCG lymphadenitis

  1. Teik Beng Khoo2
  1. 1Paediatric Neurology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
  2. 2Paediatric Neurology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
  1. Correspondence to Dr Poorani Anandakrishnan, drpoorania6{at}gmail.com
  • Accepted 20 May 2018
  • Published 30 May 2018

Summary

Cerebral demyelination and optic neuritis are often seen in children with acute disseminated encephalomyelitis following various infections and immunisations. An eight month old girl presented with a left axillary lymph node swelling and an erythematous lace-like rash over her cheeks and trunk. She then developed acute encephalopathy, bilateral nystagmus, right hemiparesis and left facial nerve palsy. Her electroencephalogram showed an encephalopathic process and visual evoked response study were grossly abnormal. Her MRI brain showed hyperintensities in the midbrain, pons and bilateral cerebellar peduncles. She was treated as postinfectious cerebral demyelination with intravenous antibiotics, methylprednisolone and immunoglobulin. Left axillary lymph node excision biopsy and GeneXpert test detected Mycobacterium tuberculosis complex that prompted initiation of antituberculous therapy. Her chest X-ray and cerebrospinal fluid examinations for tuberculosis were normal. She showed significant recovery after 2 weeks. This case illustrates a rare presentation of cerebral demyelination and bilateral optic neuritis following suppurative BCG lymphadenitis.

Footnotes

  • Contributors Both authors contributed to the conception and design, writing of the abstract and case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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