Our study suggests that rubella encephalitis should be suspected in children with eruptive fevers and neurologic impairments in the context of rubella outbreaks, even though eruptions were lacking on admission in 19% of cases. Suggestive routine laboratory tests are dominated by hyponatremia. In fact, a plasma sodium level <135 mmol/L was found in 66.7% of cases. The exact mechanism leading to hyponatremia was not investigated in our study but we advance the hypothesis that it could be related to an inappropriate antidiuretic hormone secretion. Neuroimaging tests were performed on all our patients. Cerebral computed tomographic findings were normal in 85.7% of cases, whereas MRI results were normal in 6 of 11 (54.5%) cases. The most frequent abnormality was cerebral edema, which can be related to either hyponatremia or seizure. Moreover, unlike herpes encephalitis, there was no preferential localization of cerebral damage. The acute phase of rubella infection is marked by an increase of immunoglobulin (M) titer in the serum, with detectable levels lasting up to 8 to 12 weeks. However, specific immunoglobulin (M) may not be detectible until more than 7 days after typical rush onset.All our patients were positive for antirubella immunoglobulin (M). The diagnosis was definitively confirmed by the results of cerebrospinal fluid samples with the detection of immunoglobulin rubella antibodies
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