tetano
Editor, Senior Moderator
BMC Infect Dis
. 2024 Sep 9;24(1):931.
doi: 10.1186/s12879-024-09844-6. Acute necrotizing encephalopathy in adult patients with influenza: a case report and review of the literature
Hsi Chen[SUP] 1 [/SUP], Shih-Chun Lan[SUP] 2 [/SUP], Yu-Lung Tseng[SUP] 1 [/SUP], Yung-Yee Chang[SUP] 1 3 [/SUP], Yan-Ting Lu[SUP] 1 [/SUP], Min-Yu Lan[SUP] 4 5 6 [/SUP]
Affiliations
The neurological complications of influenza affect mainly the pediatric Asian population. In the category of influenza-associated encephalopathy, acute necrotizing encephalopathy (ANE) is a rapidly progressive and fulminant brain disorder associated with significant neurological sequelae and mortality. To date, only a few adult cases of influenza-associated ANE have been reported. We describe a 44-year-old woman who presented with rapid progression of consciousness impairment and recurrent generalized convulsions. Influenza was diagnosed three days prior to presentation, and infection with influenza A (H3N2) pdm09 was subsequently confirmed. A diagnosis of ANE was made based on the presence of characteristic brain MRI findings, the exclusion of central nervous system infection, and an elevated serum interleukin-6 level. Pulse steroid therapy followed by tocilizumab was initiated, which led to clinical stabilization and improvement. Genetic testing revealed that the patient carried heterozygous human leukocyte antigen DQB1 03:03 and DRB1 09:01 genotypes. An analysis of the adult cases of influenza-associated ANE in the literature and the present case revealed a wide range of ages (22-71 years), a short interval (median 3 days) between the clinical onset of influenza and ANE, and a high overall mortality rate (32%). The thalamus was the most frequent (91%) location of the lesions. Our report highlights the importance of identifying this devastating but treatable neurological complication of influenza in adults, especially those of Asian descent. As a cytokine storm is the most accepted pathogenic mechanism for ANE, cytokine-directed therapies may be promising treatments for which further investigation is warranted.
Keywords: Acute necrotizing encephalopathy; Adult; Cytokine; Influenza.
. 2024 Sep 9;24(1):931.
doi: 10.1186/s12879-024-09844-6. Acute necrotizing encephalopathy in adult patients with influenza: a case report and review of the literature
Hsi Chen[SUP] 1 [/SUP], Shih-Chun Lan[SUP] 2 [/SUP], Yu-Lung Tseng[SUP] 1 [/SUP], Yung-Yee Chang[SUP] 1 3 [/SUP], Yan-Ting Lu[SUP] 1 [/SUP], Min-Yu Lan[SUP] 4 5 6 [/SUP]
Affiliations
- PMID: 39251995
- DOI: 10.1186/s12879-024-09844-6
The neurological complications of influenza affect mainly the pediatric Asian population. In the category of influenza-associated encephalopathy, acute necrotizing encephalopathy (ANE) is a rapidly progressive and fulminant brain disorder associated with significant neurological sequelae and mortality. To date, only a few adult cases of influenza-associated ANE have been reported. We describe a 44-year-old woman who presented with rapid progression of consciousness impairment and recurrent generalized convulsions. Influenza was diagnosed three days prior to presentation, and infection with influenza A (H3N2) pdm09 was subsequently confirmed. A diagnosis of ANE was made based on the presence of characteristic brain MRI findings, the exclusion of central nervous system infection, and an elevated serum interleukin-6 level. Pulse steroid therapy followed by tocilizumab was initiated, which led to clinical stabilization and improvement. Genetic testing revealed that the patient carried heterozygous human leukocyte antigen DQB1 03:03 and DRB1 09:01 genotypes. An analysis of the adult cases of influenza-associated ANE in the literature and the present case revealed a wide range of ages (22-71 years), a short interval (median 3 days) between the clinical onset of influenza and ANE, and a high overall mortality rate (32%). The thalamus was the most frequent (91%) location of the lesions. Our report highlights the importance of identifying this devastating but treatable neurological complication of influenza in adults, especially those of Asian descent. As a cytokine storm is the most accepted pathogenic mechanism for ANE, cytokine-directed therapies may be promising treatments for which further investigation is warranted.
Keywords: Acute necrotizing encephalopathy; Adult; Cytokine; Influenza.