Endocrine Abstracts

Introduction: Meningoencephalitis (ME) is defined as an inflammatory process of the brain and meninges, most often secondary to an infection, or more rarely to a dysimmune process. From a clinical point of view, ME is defined by the association of a neurological disorder (disorder of consciousness, convulsion) with a febrile meningeal syndrome.

Case Report: The patient was 24 years old and had no previous medical history. He was admitted to the emergency room with abdominal pain and vomiting, which had been present for 2 days prior to his admission in a febrile context. On examination, the patient was initially conscious, dehydrated, with meningeal stiffness, capillary blood glucose was 3.56 g/l, urine dipstick showed glycosuria with 3 criss-cross of acetone. The workup showed a hyperglycemia at 4.8 g/l, a normal ionogram, CRP at 320 and hyperleukocytosis at 130,000 predominantly PNN, a urinary tract infection at ECBU with leukocyturia at 22,000 and presence of BGN, the workup was completed by a cerebral CT scan which came back normal, and a lumbar puncture in favor of bacterial meningitis, the patient was put on rehydration, The patient was put on rehydration, insulin therapy, and C3G meningitis dose, the evolution was marked by the appearance of consciousness disorders, the patient was transferred in intensive care unit, intubated, sedated, and put on insulin therapy in SAP, the culture of the ECBU and lumbar puncture objective a sensitive Escherichia coli infection. It is therefore a meningoencephalitis complicating a urinary infection with E-coli and revealing a type 1 diabetes.

Discussion: Infectious etiology of meningoencephalitis was found in 42% of cases, a dysimmune etiology was identified in 21% of cases and in 37% of cases the etiology remained undetermined (1). The most frequent infectious causes were HSV-1, followed by VZV and Mycobacterium tuberculosis, while E-coli meningoencephalitis remained relatively rare. Cerebral CT scan is not very helpful for encephalitis and must be systematically performed before any lumbar puncture.

Conclusion: The search for meningeal stiffness in diabetic ketosis should be systematic, as should the search for a pulmonary, urinary or digestive infection. Neuro-meningeal infection can complicate a urinary infection; thus, the mortality rate of E- coli meningitis and meningoencephalitis remains very high.