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In light of fever, headache, seizures, and coma, the physicians who took care of this 11 year old girl considered the following conditions:

   Bacterial Meningitis (meningococcus, pneumococcus, H. influenzae)

   Brain abscess

   Rocky Mountain spotted fever

   Acute demyelinating encephalomyelitis due to Mycoplasma infection

   Viral meningoencephalistis (arbovirus, herpes simplex, Epstein-Burr, enterovirus)

   California group of virus (La Crosse, Jamestown Canyon, Snowshoe, Keystone)        which is transmitted by female Aedes triseriatus mosquito.

   Toxoplasmosis

   Toxic or metabolic encephalopathy

The spinal fluid showed significantly elevated titers for California encephalitis. The mortality of this illness is 0.5% with the majority recovering from the viral infection without any specific medications. Persistent seizures occurs only in about 15% of patients. Acute infections give life long immunity from similar California virus.

She got better a few days later. Final Diagnosis: Viral Encephalitis

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Leo Leonidas, MD, FAAP, Assistant Clinical Professor in Pediatrics, Tufts University School of Medicine, Boston; Attending Pediatrician, Eastern Maine Medical Center, Bangor, Maine.

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