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High-dose steroid and heparin: a novel therapy for cerebral vasculitis associated with presumed group A Streptococcus meningitis
  1. Brian Alexander Hummel1,
  2. Julie Blackburn2,
  3. Anne Pham-Huy1 and
  4. Katherine Muir3
  1. 1Division of Infectious Diseases, Immunology and Allergy, Department of Pediatrics, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
  2. 2Département de Microbiologie et Immunologie, University of Montreal Faculty of Medicine, Montreal, Quebec, Canada
  3. 3Division of Neurology, Department of Pediatrics, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
  1. Correspondence to Dr Brian Alexander Hummel; bhummel{at}cheo.on.ca

Abstract

Cerebral vasculitis is a serious complication of bacterial meningitis that can cause significant morbidity and mortality due to stroke. Currently, there are no treatment guidelines or safety and efficacy studies on the management of cerebral vasculitis in this context. Herein, we report a case of a previously well 11-year-old girl who presented with acute otitis media that progressed to mastoiditis and fulminant meningitis. Group A Streptococcus was found in blood and ear-fluid cultures (lumbar puncture was unsuccessful). Her decreased level of consciousness persisted despite appropriate antimicrobial treatment, and repeat MRI revealed extensive large vessel cerebral vasculitis. Based on expert opinion and a presumed inflammatory mechanism, her cerebral vasculitis was treated with 7 days of pulse intravenous methylprednisolone followed by oral prednisone taper. She was also treated with intravenous heparin. Following these therapies, she improved clinically and radiographically with no adverse events. She continues to undergo rehabilitation with improvement.

  • neurology (drugs and medicines)
  • meningitis
  • infection (neurology)
  • stroke

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Footnotes

  • Contributors All authors were involved in direct care of the patient and in contributions to literature review. BAH wrote the initial draft while JB, AP-H and KM provided guidance, comments and revisions. BAH completed the final draft.

  • 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 for publication Parents/Guardian consent obtained.

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