Neurological complications of gastrointestinal shigellosis in a child: A case report

Introduction. Shigellosis is an invasive bacterial gastroenteritis transmitted between humans or via the fecal-oral route through food and water, which can lead to extraintestinal complications, particularly neurological ones.

Observation. This observation reports the case of a 4-year-old boy admitted for incomplete febrile meningitis, generalized tonic-clonic seizures, altered consciousness, osteotendinous areflexia, weakness in the lower limbs, and drowsiness, all occurring in the context of a deterioration in his general condition. Bloody mucous diarrhea, vomiting, and diffuse abdominal pain appeared secondarily. Brain CT scan, cytobacteriological and biochemical examination of CSF, and neuromeningeal PCR were normal. Laboratory tests showed a CRP of 397 mg/L, hepatic cytolysis (ALAT 234 U/L, ASAT 589 U/L), renal abnormalities (urea 0.79 g/L; creatinine 7 mg/L), and hypoglycemia. Gastrointestinal PCR was positive for Shigella/enteropathogenic Escherichia coli (EIEC). The child received rectal diazepam (0.5 mg/kg) during seizures and a third-generation cephalosporin (C3G) at a meningeal dose followed by a conventional dose, with rapid clinical and biological improvement within 48 hours.

Conclusion. Seizures associated with shigellosis occur predominantly in children and are based on multifactorial mechanisms (fever, metabolic disorders, possible toxins). Early recognition of the digestive link allows for optimized management and avoids unnecessary neuromeningeal investigations in uncomplicated cases.