P502 Yersinia enterolitica infection with encephalopathy

We want to describe a 8 year old boy with no medical problem before. The boy came at the emergency department at the night with general weakness, hallucinations and difficulties to walk. When he arrived the temperature was 37,1°, glycemia 6,6 mmol/l. He had normal vital signs, a pulse rate of 95 beats per minute and a normal blood pressure (107/53 mmHg). He was lethargic , had hallucinations and he had a cerebellar ataxia. Pupils were dilated but reactive. Reflexes were normal. On admission standard blood test (cell count , hepatic parameter, C-reactive protein) was normal. Urine and serum toxicology screen was negative. Cerebral fluid examination revealed no white cell and a normal glucose, protein concentration. The electroencephalogram showed left temporal slow waves. Brain magnetic resonance imaging (MRI) was normal. Herpes simplex virus encephalitis was suspected and aciclovir was started. Three days later the aciclovir was stopped (PCR herpes negative), PCR enterovirus as well. At the stool culture, we found a yersinia enterocolitica, biotype 4, serotype 0:3. This pathogen agent was the only one we found. We began an antibiotic treatment when we got the result but the boy’s clinical state improved before with no more ataxia at day two of hospitalisation. The hallucinations persisted during four days. The boy was discharged at day eight. Four weeks later the electroencephalogram and MRI were normal. Clinical examination was perfect. Yersinia enterolitica is a common cause of acute gastroenteritis in our countries. The contamination by fecal-oral route, invasive forms (abscesses, septicemia) occurs in patients with underlying conditions (cirrhosis, diabetes). Secondary complications such as reactive arthritis or erythema nodosum are known. An acute or chronic neurological disease is possible but rare. On a follow up of 458 hospitalized patients in Norway 14 presented neurological manifestations. The different expressions were headache, dizziness, polyradiculitis. Another report of an 8 years old girl appeared similar to our present case (1). Yersinia enterolitica is not know to secrete a neurotoxin. Yersinia enterolitica secrete a heat stable enterotoxin and can induce immunologic response. Mechanism of acute or chronic neurological manifestations remain unclear but must not be disregard these and could induce a field of search (2). References Berner R, Kist M, Sauer M. Encephalopathy associated with yersinia enterolitica. The Lancet 1998; 351 : 418. Bancerz-kisiel A, Pieczywek M, Lada P, Szweda W. The most important virulence markers of yersinia enterolitica and the role during infection. Genes 2018 ; 9 :235–249.