Journal of Vaccines and Immunology Citation: Kurugol NZ, Gokce S, Eraslan C, Saz EU, Kizilcan S, et al. (2015) Mild Encephalitis/Encephalopathy with a Reversible Splenial Lesion Associated with Rhinovirus Infection. J Vaccines Immun 1(2): 036-038. 036 eertechz Abstract We report a 7-year-old patient with mild encephalopathy with a reversible splenial lesion (MERS) presenting with recurrent delirious behavior, hallucinations and seizures following common cold. Cranial MRI showed high signal intensity in the splenium of the corpus callosum. Rhinovirus was detected in the nasopharyngeal swab by multiplex PCR. Other respiratory viruses were not detected. Microbiologic tests for Epstein-Barr virus, herpes simplex virus, varicella-zoster virus, cytomegalovirus, measles, mumps, rubella and Mycoplasma pneumoniae were also negative. This is the irst reported case of MERS associated with rhinovirus infection. history of neurological disorders. She was not on any medication (e.g., antiepileptic). On admission, she was conscious, but sufered from delirious behavior, hallucinations and refused to walk. Her body temperature was elevated, at 38.2 °C. Clinical examination revealed no focal neurologic signs, but signs of upper respiratory tract infection were noted. Routine blood counts and biochemical investigations, including serum sodium level, were normal. Cerebrospinal luid (CSF) examinations showed normal cell counts, and protein and glucose levels, and CSF cultures were bacteriologically sterile. Polymerase chain reaction (PCR) assays of CSF for herpes simplex virus 1 and 2, inluenza virus, adenovirus, enterovirus, cytomegalovirus, human herpesvirus-6, Epstein-Barr virus and varicella zoster virus were all negative. Electroencephalography was normal. Cranial MRI showed a high intensity signal in the splenium of the corpus callosum on T2- weighted and difusion weighted images (Figure 1A, 1B). A low apparent difusion coeicient (ADC) was noted in the same area (Figure 1C). Rhinovirus was detected in a nasopharyngeal swab specimen by multiplex PCR. PCR products were detected by automated polyacrylamide gel electrophoresis using Screen Tape multiple detection system. Specimens which were positive for viral nucleic acids have been further studied by using speciic DPO primers, FluA ACE Subtyping and RV15 Screening (Seegene, South Korea) kits. Rhinovirus types A and B, four inluenza-A virus subtype human H1 (hH1), human H3 (hH3), swine H1 (sH1), avian H5 (aH5)] and 11 other respiratory viruses [Adenovirus, parainluenza virus (PIV) types 1-4, human bocavirus (HBoV), human metapneumovirus (HMPV), human coronaviruses (HCoV) OC43, 229E/NL63] were investigated with those tests. While multiplex PCR for other respiratory viruses were negative, rhinovirus was positive. Microbiologic tests for Epstein-Barr virus, herpes simplex virus, varicella-zoster virus, cytomegalovirus, measles, mumps, rubella and Mycoplasma pneumoniae were also negative. Empirical treatment with acyclovir and oseltamivir was administered until the result of laboratory investigations for herpes and inluenza virus proved to Introduction Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a clinoco-radiological entity irst described by Tada et al. [1]. he clinical manifestations consist of relatively mild neurologic symptoms, most commonly delirious behavior, consciousness disturbance and seizures. Magnetic resonance imaging (MRI) typically shows reversible lesions with reduced difusion in the splenium of the corpus callosum (SCC), sometimes associated with symmetrical white matter lesions [2]. he clinico-radiological entity has been mainly described in patients of South-East-Asian origin. here have been only few case reports from Europe or North America [3,4]. Previous studies have suggested that MERS is mostly associated with inluenza virus, mumps virus, rotavirus and adenovirus infections [2,5]. It has also been reported to be associated with other infectious diseases such as parainluenza virus, measles, human herpesvirus-6, varicella- zoster virus, parvovirus B19, Epstein-Barr virus, streptococcus, Escherichia coli, Salmonella enteritidis, Mycoplasma pneumonia and Legionella pneumophila. Similar indings have been described in some noninfectious conditions such as antiepileptic medication, Kawasaki disease and hypoglycemia. Familial cases have also been published. In this report, we present a case of MERS associated with rhinovirus infection. To our knowledge, this is the irst description of MERS in association with rhinovirus infection. Case Report A previously healthy 7-year-old girl was admitted to our emergency department with recurrent delirious behavior, seizures, paresthesia in the upper and lower extremities and refusing to walk. hree days before admission, she developed sneezing, cough, rhinorrhea and nasal congestion. here was no family history or past Case Report Mild Encephalitis/Encephalopathy with a Reversible Splenial Lesion Associated with Rhinovirus Infection N Zafer Kurugol 1 , Sule Gokce 2 , Cenk Eraslan 2 , E Ulas Saz 3 , Sirmen Kizilcan 2 and M Ozgur Cogullu 4 1 Department of Pediatrics, Professor, Doctor, Ege University Medical Faculty, Turkey 2 Department of Pediatrics, MD, Ege University Medical Faculty, Turkey 3 Department of Pediatrics, Associated Professor, Ege University Medical Faculty, Section of Pediatric Emergency Medicine, Turkey 4 Department of Pediatrics, Professor Doctor, Ege University Medical Faculty, Division of Pediatric Genetics, Turkey Dates: Received: 25 August, 2015; Accepted: 29 September, 2015; Published: 01 October, 2015 *Corresponding author: N Zafer Kurugol, Professor, Doctor, Department of Pediatrics, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey, Tel: +90 537 250 15 36; +90 232 390 12 44; E-mail: www.peertechz.com Keywords: Mild encephalitis/encephalopathy with a reversible splenial lesion; Rhinovirus; Steroid