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The Case Report of a Survival from Ekiri Syndrome

Author(s): Seyed Mehdi Monajemzadeh; Sheedeh Assar; Ali Akbar Momen

Journal: Iranian Journal of Pediatrics
ISSN 2008-2142

Volume: 17;
Issue: 4;
Start page: 375;
Date: 2007;
Original page

Keywords: Ekiri syndrome | Shigellosis

Background: Lethal toxic encephalopathy of shigellosis (Ekiri syndrome) is a rare complication of the shigella infection presented with fever, severe toxicity, seizure and diffuse brain edema, coma and death in the absence of dehydration and is nearly always lethal. This report is about a child who has survived the Ekiri syndrome.Case presentation: A three-year old child was admitted to the emergency ward because of fever, one attack of generalized tonic-clonic seizure, drowsiness and diarrhea with no signs of dehydration. The differential diagnosis was meningitis, shigellosis and atypical febrile convulsion. All test results for blood, urine, stool and cerebro-spinal fluid samples were normal except for serum sodium (119 mmol/l) and stool exam (many RBCs). He was treated with anticonvulsants because of the recurrent seizures and ceftriaxone with probability of shigellosis. The emergency brain CT scan showed diffuse brain edema. After 48 hours the consciousness was improved. Stool culture showed the growth of Shigella flexneri. Second brain CT scan revealed a dramatic decrease of the brain edema.Conclusion: Because neurological symptoms are among the extra intestinal complications of the shigellosis, it is recommended to put this disease in the list of differential diagnosis of unexplained neurological signs in endemic areas and consider the specific medications in the treatment programs.
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