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

BMJ Case Rep. 2018 May 30:2018:bcr2018224496. doi: 10.1136/bcr-2018-224496.

Abstract

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.

Keywords: neurology; paediatrics; tuberculosis.

Publication types

  • Case Reports

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • BCG Vaccine / adverse effects*
  • Brain Diseases / drug therapy
  • Demyelinating Diseases / drug therapy
  • Drug Therapy, Combination
  • Encephalomyelitis, Acute Disseminated / chemically induced*
  • Female
  • Humans
  • Infant
  • Magnetic Resonance Imaging
  • Male
  • Mycobacterium bovis
  • Optic Neuritis / chemically induced*
  • Tuberculosis, Central Nervous System / chemically induced
  • Tuberculosis, Lymph Node / chemically induced*

Substances

  • Anti-Bacterial Agents
  • BCG Vaccine