Acute Appendicitis, Peritonitis, Shock and Encephalitis; A rare combination caused by Epstein-Barr virus.

Abstract

A nine-year old girl presented in shock preceded by fever vomiting, lower abdominal pain and rebound tenderness with signs of peritonitis. Ultrasonography supported a diagnosis of acute appendicitis confirmed later by the presence of peritoneal fluid and by histopathology. She had also the clinical picture of meningo-encephalitis with positive meningeal signs and an abnormal electroencephalogram (EEG). Cerebrospinal fluid (CSF) showed high protein, normal cell count and normal pressure. Brain CT scan and MRI were normal. The polymerase chain reaction (PCR) in the blood was highly positive for Epstein Barr virus (EBV). She improved dramatically after urgent appendectomy with supportive management. This case is unusual in presenting with a combination of acute appendicitis, peritonitis and shock associated with acute encephalitis.