[P1-33] A Case of Repeated Episodes of MERS with Carnitine Palmitoyl Transferase II (CPT II) polymorphism
The high incidence of acute encephalopathy in East Asia suggests the involvement of genetic factors in its pathogenesis. It has been reported that variation of the CPT II gene may be associated with fatal or severe encephalopathy. We report a case of 8-year old boy who repeated encephalopathic episodes 5 times, including 4 episodes of criteria compatible-MERS (clinically mild encephalitis/encephalopathy with a reversible splenial lesion). He has a past history of febrile seizure in infancy, and has been diagnosed as autism spectrum disorder. He repeated episodes of encephalopathic state once a year since he was 2 years old. All episodes were accompanied by fever and convulsions, along with varying symptoms. The pathogens causing fever included Streptococcus pyogenes, RS virus and influenza virus. The brain MRI revealed high intensity lesions in the splenium of the corpus callosum on diffusion, which consequently disappeared. He recovered without any neurological complications. Gene analysis revealed CPT II polymorphism. At present, the CPT II polymorphism is supposed to be associated with severe acute encephalopathic aggravation. Although the clinical implication of CPT II polymorphism in MERS needs to be further elucidated, we suggest that it may be associated with the onset and repetition of MERS with a favourable prognosis like our case.