The Case Report of a Survival from Ekiri Syndrome|
Seyed Mehdi Monajemzadeh; Sheedeh Assar & Ali Akbar Momen
Background: Lethal toxic encephalopathy of shigellosis (Ekiri syndrome) is a rare complication of
the shigella infection presented with fever, severe toxicity, seizure and diffuse brain edema, coma and
death in the absence of dehydration and is nearly always lethal. This report is about a child who has
survived the Ekiri syndrome.
Case presentation: A three-year old child was admitted to the emergency ward because of fever, one
attack of generalized tonic-clonic seizure, drowsiness and diarrhea with no signs of dehydration. The
differential diagnosis was meningitis, shigellosis and atypical febrile convulsion. All test results for
blood, urine, stool and cerebro-spinal fluid samples were normal except for serum sodium (119
mmol/l) and stool exam (many RBCs). He was treated with anticonvulsants because of the recurrent
seizures and ceftriaxone with probability of shigellosis. The emergency brain CT scan showed diffuse
brain edema. After 48 hours the consciousness was improved. Stool culture showed the growth of
Shigella flexneri. Second brain CT scan revealed a dramatic decrease of the brain edema.
Conclusion: Because neurological symptoms are among the extra intestinal complications of the
shigellosis, it is recommended to put this disease in the list of differential diagnosis of unexplained
neurological signs in endemic areas and consider the specific medications in the treatment programs.
Ekiri syndrome, Encephalopathy, Shigella, Shigellosis, Seizure