A 4-year-old boy who became blind, deaf and mute after status epilepticus caused by hyperpyrexia from shigellosis is reported from the Sophia Children’s Hospital, Rotterdam, The Netherlands. Hyperpyrexia and diarrhea developed 2 days after eating tainted Chinese food at a family feast. Stool cultures grew Shigella flexneri. CT showed cerebral swelling. He had several generalized tonic clonic seizures followed by status and prolonged coma. On day 9 he opened his eyes and localized painful stimuli. He was blind, deaf and mute. Vision and hearing recovered within 6 months but expressive language impairment was more persistent. At 4 year follow-up he could repeat simple sentences and speech was more fluent. A “disconnection syndrome” was proposed to explain the language deficit. [1]

COMMENT. A reversible case of Kluver-Bucy syndrome in a 7-year-old child suffering from Shigella flexneri encephalopathy is reported from the Hebrew Univ of Jerusalem, Israel [2]. He was apathetic, his affect was dull, he did not recognize common objects or his relatives, he touched and placed objects in his mouth impulsively, and he exhibited an insatiable appetite and signs of bulimia. Hypermetamorphosis, a tendency to be distracted by minute visual stimuli, was questionable, and abnormal sexual behavior was absent. The patient showed 4 of the 6 classical signs of the K-B syndrome, a rare occurrence in children, and recovery was previously unreported.

Shigellae are chiefly waterborne, and foods were incriminated in only 8 of 366 outbreaks in one report, the organism spread by fecal contamination and improper food handling. (Environmental Poisons in Our Food. PNB Publishers, 1993). Children under 10 years of age are at greatest risk, and a neurotoxin produced by Shigella shiga has been implicated as a possible convulsive agent. The incidence of febrile convulsions with shigellosis is as high as 45% in some reports whereas shigella-negative diarrheas caused convulsions in less than 2%. The incidence was independent of the species of Shigella, that included Flexner and Sonne, dysenteries not associated with neurotoxin formation. [3]