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8.3Â kg, 1 y girl baby, was admitted with pneumonia, after 3 days of non good response to usual guidlines, Physician found that she has leigh syndrome, we shifted to encephalitis antibiotics and she is improved.
1. Are there needed supplements for leigh disease?
2. Was it right to shift to encephalitis antibiotics, regardless of the case improvement?
There is no proven treatment for Leigh syndrome. However, patients with suspected Leigh syndrome should be treated with biotin (10 mg/kg) and thiamine (20 mg/kg) daily, since biotin-thiamine-responsive basal ganglia disease (BTBGD) is a treatable condition that mimics Leigh syndrome.
In addition to biotin and thiamine, it is also reasonable to treat Leigh syndrome empirically with a combination of antioxidant and oxidative phosphorylation cofactors, including CoQ10, carnitine supplementation, vitamin B2 (riboflavin), alpha-lipoic acid, creatine monohydrate, and vitamin E
Was it right to shift to encephalitis antibiotics, regardless of the case improvement?
Yes, it was clinically reasonable to broaden coverage to encephalitis-targeted antibiotics in this context.
Here’s why:
- Leigh syndrome can mimic CNS infections (e.g., altered consciousness, seizures, lactic acidosis).
- However, CNS infections can still occur, and immunocompromised states or metabolic vulnerabilities may predispose to infections or atypical presentations.
- If the initial pneumonia treatment failed and neurological symptoms emerged, it’s justifiable to empirically cover CNS infections (bacterial meningitis/encephalitis), especially in infants.
Typical empirical encephalitis antibiotics include:
- Vancomycin + 3rd gen cephalosporin (like cefotaxime or ceftriaxone) for bacterial causes.
- Acyclovir if viral encephalitis (e.g., HSV) is suspected.
If there’s no lumbar puncture or clear diagnosis at the time, empirical treatment is often the safest route, especially in a deteriorating infant.