October 1992

Pathological Case of the Month

Author Affiliations

From the Department of Pediatric Infectious Diseases, Hacettepe University, Ankara, Turkey (Drs Ceyhan, Kanra, and Yilmaz), and the Department of Pathology, Institute of Rabies (Drs Secmeer and Saylan), Ankara University.

Am J Dis Child. 1992;146(10):1215-1216. doi:10.1001/archpedi.1992.02160220101032

A 10-year-old previously healthy boy had a 2-day history of headache, nausea, meaningless speech, difficulty in walking, and an itchy rash on the lower extremities. He had head trauma 3 months previously. There was no contact with any animal. He was disoriented, agitated, and hallucinating. There was bilateral minimal papilledema. Neurologic examination revealed a stiff neck, Kernig's sign, and normoactive cranial and deep tendon reflexes. Motor and sensory systems were normal. He had hypernatremia (sodium level, 168 mmol/L), azotemia (blood urea nitrogen level, 24.0 mmol/L), and hyperuricemia (960 μmol/L). Aspartate aminotransferase, alanine aminotransferase, and creatine phosphokinase levels were very high (781 U/L, 2178 U/L, and 25 130 U/L, respectively). Results of a toxicologic screening, a Vidal test, a titer to detect the human immunodeficiency virus, and antibody titers to detect adenovirus and herpes, measles, mumps, and Epstein-Barr viruses were normal. Levels of ammonia in blood, antinuclear antibodies, urine porphyrins, and

First Page Preview View Large
First page PDF preview
First page PDF preview