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Neerukonda VK, Stagner AM. Stevens Johnson syndrome: A review of a vision and life-threatening mucocutaneous disease including histopathology with updates on pathogenesis and genetic risk factors. Semin Ophthalmol 2021; 36:270-281. [PMID: 33764253 DOI: 10.1080/08820538.2021.1893764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) spectrum of diseases are devastating blistering disorders involving mucosal surfaces with ocular sequelae that manifest particularly profound long-term morbidity. Advances in deoxyribonucleic acid (DNA) sequencing, genome-wide association studies, and both molecular and pharmacogenetics have helped clarify genetic susceptibility and characterize the iatrogenic risk of SJS for a given patient. METHODS A review of peer reviewed publications featured on PubMed pertaining to the clinical, pathologic, pharmacogenetic and molecular genetic features of SJS/TEN was conducted. Propose: To provide an in-depth clinicopathologic description of the ocular, ocular adnexal, and cutaneous findings in SJS/TEN, summarize pathogenesis and related conditions, and provide an update on the molecular genetic modifications that contribute to the phenotypic variations and genetic susceptibilities of SJS. CONCLUSIONS HLA subtyping and other genetic testing may eventually be valuable in the appropriate context to prevent the debilitating ocular sequelae of SJS, particularly as it relates to medication use.
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Chhabda S, Malik P, Reddy N, Muthusamy K, Mirsky D, Sudhakar S, Mankad K. Relapsing Demyelinating Syndromes in Children: A Practical Review of Neuroradiological Mimics. Front Neurol 2020; 11:627. [PMID: 32849169 PMCID: PMC7417677 DOI: 10.3389/fneur.2020.00627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/28/2020] [Indexed: 01/02/2023] Open
Abstract
Relapsing demyelinating syndromes (RDS) in children encompass a diverse spectrum of entities including multiple sclerosis (MS) acute disseminated encephalomyelitis (ADEM), aquaporin-4 antibody associated neuromyelitis optica spectrum disorder (AQP4-NMOSD) and myelin oligodendrocyte glycoprotein antibody disease (MOG-AD). In addition to these, there are “antibody-negative” demyelinating syndromes which are yet to be fully characterized and defined. The paucity of specific biomarkers and overlap in clinical presentations makes the distinction between these disease entities difficult at initial presentation and, as such, there is a heavy reliance on magnetic resonance imaging (MRI) findings to satisfy the criteria for treatment initiation and optimization. Misdiagnosis is not uncommon and is usually related to the inaccurate application of criteria or failure to identify potential clinical and radiological mimics. It is also notable that there are instances where AQP4 and MOG antibody testing may be falsely negative during initial clinical episodes, further complicating the issue. This article illustrates the typical clinico-radiological phenotypes associated with the known pediatric RDS at presentation and describes the neuroimaging mimics of these using a pattern-based approach in the brain, optic nerves, and spinal cord. Practical guidance on key distinguishing features in the form of clinical and radiological red flags are incorporated. A subsection on clinical mimics with characteristic imaging patterns that assist in establishing alternative diagnoses is also included.
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Affiliation(s)
- Sahil Chhabda
- Department of Radiology, Great Ormond Street Hospital, London, United Kingdom
| | - Prateek Malik
- Christian Medical College & Hospital, Vellore, India
| | | | | | - David Mirsky
- Children's Hospital Colorado, Aurora, CO, United States
| | - Sniya Sudhakar
- Department of Radiology, Great Ormond Street Hospital, London, United Kingdom
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital, London, United Kingdom.,Associate Honorary Professor, Institute of Child Health, University College London, London, United Kingdom
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3
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D'Alonzo R, Mencaroni E, Di Genova L, Laino D, Principi N, Esposito S. Pathogenesis and Treatment of Neurologic Diseases Associated With Mycoplasma pneumoniae Infection. Front Microbiol 2018; 9:2751. [PMID: 30515139 PMCID: PMC6255859 DOI: 10.3389/fmicb.2018.02751] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 10/26/2018] [Indexed: 12/14/2022] Open
Abstract
Mycoplasma pneumoniae is mainly recognized as a respiratory pathogen, although it is associated with the development of several extra-respiratory conditions in up to 25% of the cases. Diseases affecting the nervous system, both the peripheral (PNS) and the central nervous system (CNS), are the most severe. In some cases, particularly those that involve the CNS, M. pneumoniae-related neuropathies can lead to death or to persistent neurologic problems with a significant impact on health and a non-marginal reduction in the quality of life of the patients. However, the pathogenesis of most of the M. pneumoniae-related neuropathies remains undefined. The main aim of this paper is to discuss what is presently known regarding the pathogenesis and treatment of the most common neurologic disorders associated with M. pneumoniae infection. Unfortunately, the lack of knowledge of the true pathogenesis of most of the cases of M. pneumoniae-mediated neurological diseases explains why treatment is not precisely defined. However, antibiotic treatment with drugs that are active against M. pneumoniae and able to pass the blood-brain barrier is recommended, even though the best drug, dosage, and duration of therapy have not been established. Sporadic clinical reports seem to indicate that because immunity plays a relevant role in the severity of the condition and outcome, attempts to reduce the immune response can be useful. However, further studies are needed before the problem of the best therapy for M. pneumoniae-mediated neurological diseases can be efficiently solved.
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Affiliation(s)
- Renato D'Alonzo
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Elisabetta Mencaroni
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Lorenza Di Genova
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Daniela Laino
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | | | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
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4
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Tomotaki S, Shibasaki J, Yunoki Y, Kishigami M, Imagawa T, Aida N, Toyoshima K, Itani Y. Effectiveness of Corticosteroid Therapy for Acute Neurological Symptoms in Incontinentia Pigmenti. Pediatr Neurol 2016; 56:55-58. [PMID: 26777982 DOI: 10.1016/j.pediatrneurol.2015.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 12/12/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Incontinentia pigmenti is a rare neurocutaneous disorder that may result in neurological symptoms in addition to its characteristic skin rashes. The pathogenesis of central nervous system disorders in incontinentia pigmenti remains unclear, but it has been suggested that vascular abnormalities and inflammatory processes may play important roles. Notably, there is no established treatment for central nervous system disorders in incontinentia pigmenti. We report a neonate with acute neurological symptoms of incontinentia pigmenti who was effectively treated with corticosteroid therapy. We review the literature and discuss the pathophysiology, diagnosis, and treatment of acute central nervous system disorders in incontinentia pigmenti. PATIENT DESCRIPTION A 15-day-old girl with incontinentia pigmenti experienced neurological symptoms such as decreased level of consciousness and a weak sucking reflex. Magnetic resonance imaging revealed multiple cerebral infarctions. We administered corticosteroid therapy, and the symptoms improved immediately and significantly. CONCLUSION We suggest that corticosteroid therapy may be an effective treatment during the acute phase of central nervous system dysfunction due to incontinentia pigmenti. It is important to determine the existence of acute phase lesions on magnetic resonance imaging when neurological symptoms occur or worsen.
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Affiliation(s)
- Seiichi Tomotaki
- Department of Neonatology, Kanagawa Children's Medical Center, Yokohama city, Kanagawa Prefecture, Japan.
| | - Jun Shibasaki
- Department of Neonatology, Kanagawa Children's Medical Center, Yokohama city, Kanagawa Prefecture, Japan
| | - Yuki Yunoki
- Department of Neonatology, Kanagawa Children's Medical Center, Yokohama city, Kanagawa Prefecture, Japan
| | - Makoto Kishigami
- Department of Neonatology, Kanagawa Children's Medical Center, Yokohama city, Kanagawa Prefecture, Japan
| | - Tomoyuki Imagawa
- Department of Infectious Disease and Immunology, Kanagawa Children's Medical Center, Yokohama city, Kanagawa Prefecture, Japan
| | - Noriko Aida
- Department of Radiology, Kanagawa Children's Medical Center, Yokohama city, Kanagawa Prefecture, Japan
| | - Katsuaki Toyoshima
- Department of Neonatology, Kanagawa Children's Medical Center, Yokohama city, Kanagawa Prefecture, Japan
| | - Yasufumi Itani
- Department of Neonatology, Kanagawa Children's Medical Center, Yokohama city, Kanagawa Prefecture, Japan
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5
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Narita M. Classification of Extrapulmonary Manifestations Due to Mycoplasma pneumoniae Infection on the Basis of Possible Pathogenesis. Front Microbiol 2016; 7:23. [PMID: 26858701 PMCID: PMC4729911 DOI: 10.3389/fmicb.2016.00023] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 01/11/2016] [Indexed: 01/22/2023] Open
Abstract
The list of extrapulmonary manifestations due to Mycoplasma pneumoniae infection can be classified according to the following three possible mechanisms derived from the established biological activity of M. pneumoniae; (1) a direct type in which the bacterium is present at the site of inflammation and local inflammatory cytokines induced by the bacterium play an important role (2) an indirect type in which the bacterium is not present at the site of inflammation and immune modulations, such as autoimmunity or formation of immune complexes, play an important role, and (3) a vascular occlusion type in which obstruction of blood flow induced either directly or indirectly by the bacterium plays an important role. Recent studies concerning extrapulmonary manifestations have prompted the author to upgrade the list, including cardiac and aortic thrombi as cardiovascular manifestations; erythema nodosum, cutaneous leukocytoclastic vasculitis, and subcorneal pustular dermatosis as dermatological manifestations; acute cerebellar ataxia, opsoclonus-myoclonus syndrome, and thalamic necrosis as neurological manifestations; pulmonary embolism as a respiratory system manifestation; and renal artery embolism as a urogenital tract manifestation. Continuing nosological confusion on M. pneumoniae–induced mucositis (without skin lesions), which may be called M. pneumoniae-associated mucositis or M. pneumoniae-induced rash and mucositis separately from Stevens-Johnson syndrome, is argued in the dermatological manifestations. Serological methods are recommended for diagnosis because pneumonia or respiratory symptoms are often minimal or even absent in extrapulmonary manifestations due to M. pneumoniae infection. Concomitant use of immunomodulators, such as corticosteroids or immunoglobulins with antibiotics effective against M. pneumoniae, can be considered as treatment modalities for most severe cases, such as encephalitis. Further studies would be necessary to construct a comprehensive therapeutic strategy, covering microbiology (antibiotics), immunology (immunomodulators), and hematology (anticoagulants). The possible influence of the emergence of macrolide-resistant M. pneumoniae on extrapulmonary manifestations, which can be considered of limited clinical threat in Japan where the resistant rate has currently decreased, is discussed on the basis of unique biological characteristics of M. pneumoniae, the smallest self-replicating organism.
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Affiliation(s)
- Mitsuo Narita
- Department of Pediatrics, Sapporo Tokushukai Hospital Sapporo, Japan
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6
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Wolf DS, Golden WC, Hoover-Fong J, Applegate C, Cohen BA, Germain-Lee EL, Goldberg MF, Crawford TO, Gauda EB. High-dose glucocorticoid therapy in the management of seizures in neonatal incontinentia pigmenti: a case report. J Child Neurol 2015; 30:100-6. [PMID: 24682289 DOI: 10.1177/0883073813517509] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Incontinentia pigmenti is an X-linked dominant disorder resulting from a mutation of IKBKG. This disorder has a classic dermatologic presentation, but neurologic involvement, with seizures and cortical infarction, can arise shortly after birth. There are no specific therapies available for the manifestations of incontinentia pigmenti. Here, we describe the clinical, electrographic, and neuroradiologic effect of systemic glucocorticoid therapy in a neonate with incontinentia pigmenti manifesting an epileptic encephalopathy. Treatment with dexamethasone led to a dramatic reduction in seizure activity and improvement in bullous lesions. A novel mutation in IKBKG is also reported.
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Affiliation(s)
- David S Wolf
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA Division of Pediatric Neurology, Emory University/Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - W Christopher Golden
- Department of Pediatrics, Eudowood Neonatal Pulmonary Division, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julie Hoover-Fong
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carolyn Applegate
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bernard A Cohen
- Division of Pediatric Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emily L Germain-Lee
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA Kennedy Krieger Institute, Baltimore, MD, USA Division of Pediatric Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Morton F Goldberg
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas O Crawford
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Estelle B Gauda
- Department of Pediatrics, Eudowood Neonatal Pulmonary Division, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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7
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Poziomczyk CS, Recuero JK, Bringhenti L, Maria FDS, Campos CW, Travi GM, Freitas AM, Maahs MAP, Zen PRG, Fiegenbaum M, Almeida STD, Bonamigo RR, Bau AEK. Incontinentia pigmenti. An Bras Dermatol 2014; 89:26-36. [PMID: 24626645 PMCID: PMC3938351 DOI: 10.1590/abd1806-4841.20142584] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 04/09/2013] [Indexed: 12/25/2022] Open
Abstract
Incontinentia pigmenti is a rare genodermatosis in which the skin involvement occurs
in all patients. Additionally, other ectodermal tissues may be affected, such as the
central nervous system, eyes, hair, nails and teeth. The disease has a X-linked
dominant inheritance pattern and is usually lethal to male fetuses. The
dermatological findings occur in four successive phases, following the lines of
Blaschko: First phase - vesicles on an erythematous base; second phase - verrucous
hyperkeratotic lesions; third phase - hyperchromic spots and fourth phase -
hypochromic atrophic lesions.
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Affiliation(s)
- Cláudia Schermann Poziomczyk
- Porto Alegre Health Sciences Federal University, Pathology Post-graduation Program, Porto AlegreRS, Brazil, MD, Dermatologist - MSc (in course) at the Pathology Post-graduation Program at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Júlia Kanaan Recuero
- Porto Alegre Health Sciences Federal University, Porto AlegreRS, Brazil, Medical Student at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Luana Bringhenti
- Porto Alegre Health Sciences Federal University, Porto AlegreRS, Brazil, Medical Student at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Fernanda Diffini Santa Maria
- Porto Alegre Health Sciences Federal University, Pathology Post-graduation Program, Porto AlegreRS, Brazil, DDS - MSc (in course) at the Pathology Post-graduation Program at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Carolina Wiltgen Campos
- Santa Casa de Misericórdia de Porto Alegre, Ophthalmology Program, Porto AlegreRS, Brazil, MD - Resident in the Ophthalmology Program at Santa Casa de Misericórdia de Porto Alegre - Porto Alegre (RS), Brazil
| | - Giovanni Marcos Travi
- Santa Casa de Misericórdia de Porto Alegre, Porto AlegreRS, Brazil, MD - Ophthalmologist with specialization in Pediatric Ophthalmology and Strabismus Licensed physician at Santa Casa de Misericórdia de Porto Alegre- Porto Alegre (RS), Brazil
| | - André Moraes Freitas
- Santa Casa de Misericórdia de Porto Alegre Ophthalmology Service, Ophthalmology Service, Retina Sector, Porto AlegreRS, Brazil, MD - Ophthalmologist - Chief of the Retina Sector at Santa Casa de Misericórdia de Porto Alegre Ophthalmology Service - Porto Alegre (RS), Brazil
| | - Marcia Angelica Peter Maahs
- Rio Grande do Sul Federal University, Porto AlegreRS, Brazil, DDS - Specialist in Orthodontics and Facial Orthopedics at Rio Grande do Sul Federal University (UFRGS). PhD in Dentistry at Rio Grande do Sul Pontifical Catholic University (PUCRS) - Substitute Professor of the Discipline of Orthodontics Applied to Speech Therapy at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Paulo Ricardo Gazzola Zen
- Porto Alegre Health Sciences Federal University, Pathology Post-graduation Program, Porto AlegreRS, Brazil, MD, PhD at the Pathology Post-graduation Program at Porto Alegre Health Sciences Federal University (UFCSPA) - Adjunct Professor of Genetics at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Marilu Fiegenbaum
- Porto Alegre Health Sciences Federal University, Basic Health Sciences Department, Porto AlegreRS, Brazil, Pharm. D. - PhD in Genetics and Molecular Biology at Rio Grande do Sul Federal University (UFRGS) - Adjunct Professor at the Basic Health Sciences Department at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Sheila Tamanini de Almeida
- Porto Alegre Health Sciences Federal University, Speech Therapy Department, Porto AlegreRS, Brazil, Speech-Language Pathologist (SLPs) - Specialist in Orofacial Motricity and Dysphagia. MSc in Health Sciences - Assistant Professor at the Speech Therapy Department at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Renan Rangel Bonamigo
- Porto Alegre Health Sciences Federal University, Pathology Postgraduation Program, Porto AlegreRS, Brazil, MD - PhD in Health Sciences at Rio Grande do Sul Federal University (UFRGS) - Head Professor of Dermatology and Professor of the Pathology Postgraduation Program at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Ana Elisa Kiszewski Bau
- Porto Alegre Health Sciences Federal University, Porto AlegreRS, Brazil, MD - PhD in Pathology at Porto Alegre Health Sciences Federal University (UFCSPA)- Adjunct Professor of Dermatology at Porto Alegre Health Sciences Federal University (UFCSPA). Pediatric Dermatologist at Santo Antonio Children's Hospital and at Santa Casa de Misericórdia de Porto Alegre - Porto Alegre (RS), Brazil
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8
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Okita M, Nakanishi G, Fujimoto N, Shiomi M, Yamada T, Wataya-Kaneda M, Takijiri C, Yokoyama Y, Sunohara A, Tanaka T. NEMOgene rearrangement (exon 4-10 deletion) and genotype-phenotype relationship in Japanese patients with incontinentia pigmenti and review of published work in Japanese patients. J Dermatol 2013; 40:272-6. [DOI: 10.1111/1346-8138.12091] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 12/17/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Mayuko Okita
- Department of Dermatology; Shiga University of Medical Science; Otsu; Japan
| | - Gen Nakanishi
- Department of Dermatology; Shiga University of Medical Science; Otsu; Japan
| | - Noriki Fujimoto
- Department of Dermatology; Shiga University of Medical Science; Otsu; Japan
| | - Mariko Shiomi
- Department of Dermatology; Japanese Red Cross Society Himeji Hospital; Himeji; Japan
| | - Taku Yamada
- Department of Dermatology; Japanese Red Cross Society Himeji Hospital; Himeji; Japan
| | - Mari Wataya-Kaneda
- Department of Dermatology; Faculty of Medicine; Osaka University; Osaka; Japan
| | - Chincho Takijiri
- Department of Dermatology; Suita Municipal Hospital; Suita; Japan
| | - Yoko Yokoyama
- Department of Dermatology; Sasebo City General Hospital; Sasebo; Japan
| | - Akiyo Sunohara
- Department of Dermatology; Holy Spirit Hospital; Nagoya; Japan
| | - Toshihiro Tanaka
- Department of Dermatology; Shiga University of Medical Science; Otsu; Japan
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Meuwissen ME, Mancini GM. Neurological findings in incontinentia pigmenti; a review. Eur J Med Genet 2012; 55:323-31. [DOI: 10.1016/j.ejmg.2012.04.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 04/22/2012] [Indexed: 10/28/2022]
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10
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Bitnun A, Richardson SE. Mycoplasma pneumoniae: Innocent Bystander or a True Cause of Central Nervous System Disease? Curr Infect Dis Rep 2011; 12:282-90. [PMID: 21308543 DOI: 10.1007/s11908-010-0105-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The consistency with which Mycoplasma pneumoniae has been implicated as a cause of encephalitis, and the increased incidence of central nervous system (CNS) disease observed during M. pneumoniae respiratory outbreaks, support the role of M. pneumoniae as a CNS pathogen. Three pathophysiologic mechanisms have been proposed: direct infection, autoimmunity, and vascular occlusion. Recent evidence demonstrating the organism's ability to survive intracellularly, presence of its DNA in the serum of individuals with acute encephalitis, case reports in which the organism is detected in brain parenchyma or cerebrospinal fluid (CSF), and animal data demonstrating CNS invasion by several Mycoplasma species support the contention that M. pneumoniae is capable of direct infection of the CNS. Because of limitations of current serologic assays and difficulty in interpreting the significance of positive polymerase chain reaction results in regard to acuity of infection and viability of the organism, the diagnosis of M. pneumoniae-associated CNS disease should be based on a combination of positive tests and exclusion of alternative diagnoses.
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Affiliation(s)
- Ari Bitnun
- Division of Infectious Diseases, Department of Paediatrics, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada,
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