The Case Report of a Survival from Ekiri Syndrome

Background: Lethal toxic encephalopathy of shigellosis (Ekiri syndrome) is a rare complication ofthe shigella infection presented with fever, severe toxicity, seizure and diffuse brain edema, coma anddeath in the absence of dehydration and is nearly always lethal. This report is about a child who hassurvived the Ekiri syndrome.Case presentation: A three-year old child was admitted to the emergency ward because of fever, oneattack of generalized tonic-clonic seizure, drowsiness and diarrhea with no signs of dehydration. Thedifferential diagnosis was meningitis, shigellosis and atypical febrile convulsion. All test results forblood, urine, stool and cerebro-spinal fluid samples were normal except for serum sodium (119mmol/l) and stool exam (many RBCs). He was treated with anticonvulsants because of the recurrentseizures and ceftriaxone with probability of shigellosis. The emergency brain CT scan showed diffusebrain edema. After 48 hours the consciousness was improved. Stool culture showed the growth ofShigella flexneri. Second brain CT scan revealed a dramatic decrease of the brain edema.Conclusion: Because neurological symptoms are among the extra intestinal complications of theshigellosis, it is recommended to put this disease in the list of differential diagnosis of unexplainedneurological signs in endemic areas and consider the specific medications in the treatment programs.