We read the recent article by Cree et al1 with great interest. The authors present a case of a 33-year-old woman previously treated with immunosuppressive agents for Henoch-Schönlein purpura. Progressive development of initially flulike symptoms to severe neurological impairment with lethargy, cogwheeling, increased limb tone, and brisk reflexes was diagnosed as coxsackievirus B4 meningoencephalitis. Experimental therapy with the antiviral agent pleconaril was ineffective. Magnetic resonance imaging showed focal hyperintense lesions in the brainstem that correlated with pathologic findings seen at autopsy after fatal central nervous system infection and myocarditis.
Lanczik O, Lecei O, Schwarz S, Hennerici M. Mycoplasma pneumoniae Infection as a Treatable Cause of Brainstem Encephalitis. Arch Neurol. 2003;60(12):1813. doi:10.1001/archneur.60.12.1813-a