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Chronic meningitis with intracranial hypertension and bilateral neuroretinitis following Mycoplasma pneumoniae infection
  1. Konstantinos Karampatsas1,
  2. Himanshu Patel2,3,
  3. Sheikh N Basheer4,
  4. Andrew J Prendergast5
  1. 1Department of Paediatrics, The Royal London Hospital, Barts Health NHS Trust, London, UK
  2. 2Department of Ophthalmology, The Royal London Hospital, Barts Health NHS Trust, London, UK
  3. 3Moorfields Eye Hospital, London, UK
  4. 4Department of Paediatric Neurology, The Royal London Hospital, Barts Health NHS Trust, London, UK
  5. 5Centre for Paediatrics, Blizard Institute, Queen Mary University of London, London, UK
  1. Correspondence to Dr Konstantinos Karampatsas, kostaskarab{at}


A previously well 12-year-old boy presented with a 2-week history of headache, nausea, vomiting and left-sided weakness. He subsequently developed meningism, right abducens nerve palsy, persistent papilloedema and reduced visual acuity in association with a bilateral macular star, consistent with neuroretinitis. Cerebrospinal fluid (CSF) examination indicated chronic meningitis and serological testing confirmed recent Mycoplasma pneumoniae infection, although PCR in CSF was negative. He was treated for aseptic meningitis with ceftriaxone, aciclovir, azithromycin and acetazolamide for intracranial hypertension, with gradual improvement in clinical condition and visual acuity over several weeks. This is the first report of M. pneumoniae chronic meningitis further complicated with bilateral neuroretinitis and intracranial hypertension. Evidence of central nervous system inflammation in the absence of direct infection suggests an immune-mediated pathophysiology. Although the use of macrolides with antibiotic and immunomodulatory activity might be beneficial, it was not possible to ascertain whether it influenced clinical recovery in this case.

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