Corticosteroids in the treatment of severe mycoplasma encephalitis in children

OBJECTIVE: To report an unusual case of mycoplasma-associated encephalitis that responded to corticosteroid therapy and relapsed after cessation. DESIGN: Clinical case report. SETTING: Tertiary care pediatric intensive care unit. PATIENT: A single patient admitted to the pediatric intensive care unit. INTERVENTIONS: Intravenous corticosteroids and antibiotics. MEASUREMENTS AND MAIN RESULTS: Resolution of neurologic symptoms with initial steroid therapy, relapse after withdrawal of steroids, and resolution again with re-institution of steroid therapy. CONCLUSIONS: Encephalitis is a well-recognized and potentially severe complication of mycoplasma infections. Treatment with corticosteroids has been proposed for this illness, but experience with this therapy is limited to case reports and small series; neither efficacy nor appropriate courses of treatment are well established. The relapsing course of this patient, along with a review of prior reported cases, suggests that corticosteroids may be beneficial for mycoplasma encephalitis, that moderate doses may be sufficient, and that consideration should be given to a prolonged tapering course when these medications are used for this illness.