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This report describes a rare case in which literature review supported the simultaneous occurrence of multiple cerebral infarctions and MERS. A 49-year-old man developed fever and sore throat, followed by sepsis, septic coagulopathy, and MRI findings consistent with MERS, with intensive care and favorable outcome after discharge.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/multiple-cerebral-infarctions-and-clinically-mild-encephalitisencephalopathy-with-a-reversible-splenial-lesion-associated-with-streptococcal-toxic-shock-syndrome-a-case-report/460440/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/multiple-cerebral-infarctions-and-clinically-mild-encephalitisencephalopathy-with-a-reversible-splenial-lesion-associated-with-streptococcal-toxic-shock-syndrome-a-case-report/460440.png","ImageObject",300,407,{"name":92,"@type":93},"dabgoudw","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-28","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is STSS and why is it clinically important?","Question",{"text":112,"@type":113},"STSS is caused by toxin-producing hemolytic streptococci and can rapidly progress within 24 hours, leading to shock, disseminated intravascular coagulation, and multiple organ failure.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How were multiple cerebral infarctions and MERS identified in the case?",{"text":117,"@type":113},"Brain MRI showed diffusion-weighted high signal intensities consistent with cerebral infarction, and high signal intensity in the splenium of the corpus callosum was considered MERS; later outpatient MRI supported a definitive MERS diagnosis.",{"name":119,"@type":110,"acceptedAnswer":120},"What treatment approach and outcome were reported?",{"text":121,"@type":113},"The patient received intensive care for sepsis complicated by septic coagulopathy and supportive management for the neurologic conditions, was discharged on day 32, and had a favorable prognosis.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},460440,1791090571,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":46,"preview_page_count":4},3985747860484,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Case Reports in Neurology  \n\n| Case Rep Neurol 2026;18:9–16 |  |\n| --- | --- |\n| DOI: 10. 1159/000549886\u003Cbr>Received: October 1, 2025\u003Cbr>Accepted: November 28, 2025\u003Cbr>Published online: December 5, 2025 | © 2025 The Author(s) .\u003Cbr>Published by S. Karger AG, Basel [www.karger.com/crn](www.karger.com/crn) |\n\nThis article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) ([https://karger.com/Services/OpenAccessLicense](https://karger.com/Services/OpenAccessLicense)). Usage and distribution for commercial purposes requires written permission.  \nSingle Case – Cerebrovascular Diseases and Stroke  \nMultiple Cerebral Infarctions and Clinically Mild Encephalitis/ Encephalopathy with a Reversible Splenial Lesion Associated with Streptococcal Toxic Shock Syndrome:  \nA Case Report  \nHiroto Okubataa Daiki Wada a Tomoyuki Yoshihara a Fukuki Saito a Kazuhisa Yoshiya a Kunikazu Yoshimurab Yasushi Nakamoria Yasuyuki Kuwagatac  \na Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, Osaka, Japan; b Department of Neurosurgery, Kansai Medical University General Medical Center, Osaka, Japan; c Department of Emergency and Critical Care Medicine, Kansai Medical University Hospital, Osaka, Japan  \nKeywords  \nCerebral infarction · Clinically mild encephalitis · Encephalopathy with a reversible spleniallesion · Sepsis-induced coagulopathy  \nAbstract  \nIntroduction: Streptococcal toxic shock syndrome (STSS) is a rapidly progressing, fatal disease. Sepsis can be complicated by multiple cerebral infarctions, clinically mild encephalitis/ encephalopathy with a reversible splenial lesion (MERS), and sepsis-related encephalopathy, resulting in a poor prognosis. To our knowledge, there have been no reported cases of sepsis complicated by both multiple cerebral infarctions and MERS. We report a case based on a literature review. Case Presentation: The patient was a 49-year-old man who experienced fever and a sore throat for 2 weeks prior to his visit. He was diagnosed with tonsillitis. Two days prior to his visit, he was confused and was transported to his previous hospital, where he was diagnosed with sepsis and treated conservatively. Although his confusion had improved the day before coming to the hospital, head magnetic resonance imaging (MRI) revealed multiple cerebral infarctions, and he was transferred to our hospital for intensive care. At the time of transfer, high signal intensity observed in the splenium of the corpus callosum on MRI was thought to be MERS. Blood tests revealed septic coagulopathy. He received intensive care and  \nCorrespondence to:  \nHiroto Okubata, evp4kow  [gmail.com](gmail.com)  \nCase Reports in Neurology  \nCase Rep Neurol 2026;18:9–16 10  \n\n| DOI: 10. 1159/000549886 | © 2025 The Author(s) . Published by S. Karger AG, Basel [www.karger.com/crn](www.karger.com/crn) |\n| --- | --- |\n\nOkubata et al.: Multiple Cerebral Infarctions and MERS Associated with Sepsis  \nwas discharged home on day 32. Head MRI performed during outpatient follow-up on the 15th day after discharge, we made a definitive diagnosis of MERS. Conclusion: We encountered avery rare case of STSS complicated by multiple cerebral infarctions and MERS, which had a favorable prognosis. The associations among sepsis, multiple cerebral infarctions, and MERS remain poorly understood, and further investigation is warranted.  \n© 2025 The Author(s) .  \nPublished by S. KargerAG, Basel  \nIntroduction  \nStreptococcal toxic shock syndrome (STSS) is caused by infection with toxin-producing strains of hemolytic streptococci, including Streptococcus pyogenes. STSS begins with fever and sore throat, and progresses rapidly within 24 h, with patients developing shock, disseminated intravascular coagulation, and multiple organ failure. The mortality rate is 30%  \n[1] . Sepsis can be accompanied by various central nervous system disorders, including cerebral infarction, clinically mild enc","cbCaiqT72GqfFq0J","https://ap.wps.com/l/cbCaiqT72GqfFq0J","pdf",2649127,"English","# Introduction\n# Case Presentation\n# Conclusion","[{\"question\":\"What is STSS and why is it clinically important?\",\"answer\":\"STSS is caused by toxin-producing hemolytic streptococci and can rapidly progress within 24 hours, leading to shock, disseminated intravascular coagulation, and multiple organ failure.\"},{\"question\":\"How were multiple cerebral infarctions and MERS identified in the case?\",\"answer\":\"Brain MRI showed diffusion-weighted high signal intensities consistent with cerebral infarction, and high signal intensity in the splenium of the corpus callosum was considered MERS; later outpatient MRI supported a definitive MERS diagnosis.\"},{\"question\":\"What treatment approach and outcome were reported?\",\"answer\":\"The patient received intensive care for sepsis complicated by septic coagulopathy and supportive management for the neurologic conditions, was discharged on day 32, and had a favorable prognosis.\"}]","Multiple Cerebral Infarctions and Clinically Mild Encephalitis/Encephalopathy with a Reversible Splenial Lesion Associated with Streptococcal Toxic Shock Syndrome - A Case Report | PDF",1790758479]