Fatal H1N1-related acute necrotising encephalopathy in an adult

Cerebrospinal fluid (CSF) analysis was not attempted given the presence of tonsillar herniation. ANE is an uncommon parainfectious condition that is usually triggered by viral infections, most commonly influenza A, B and human herpesvirus 6.3 Although the pathogenesis of ANE is unclear, it is sugges...

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Bibliographic Details
Published in:BMJ case reports 2020-06, Vol.13 (6), p.e235264
Main Authors: Arul, Judah Nijas, Madhavan, Sudha, Krishnan, Vasanthan, Krishnamoorthy, Vengadakrishnan
Format: Article
Language:English
Subjects:
Adults
Brain Diseases - diagnostic imaging
Brain Diseases - pathology
Brain Diseases - virology
Case reports
Coma
Edema
Encephalitis
Fatal Outcome
Female
Humans
Images In
infection (neurology)
Infections
Influenza
Influenza A Virus, H1N1 Subtype
Influenza, Human - complications
Influenza, Human - diagnostic imaging
Influenza, Human - pathology
Magnetic Resonance Imaging
Mortality
Necrosis
Surveillance
Viral infections
Young Adult
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Summary:Cerebrospinal fluid (CSF) analysis was not attempted given the presence of tonsillar herniation. ANE is an uncommon parainfectious condition that is usually triggered by viral infections, most commonly influenza A, B and human herpesvirus 6.3 Although the pathogenesis of ANE is unclear, it is suggested that hypercytokinemia or ‘cytokine storm’ may play an important role.4 ANE secondary to influenza is a relatively common complication of the infection seen in children but such presentation in adulthood is extremely rare with only about eight cases documented in the literature. In a 2-year surveillance study conducted through the National British Surveillance Study, 25 cases (21 children and 4 adults) had neurological manifestations and only 7 cases (6 children and 1 adult) had acute encephalopathy syndromes.5 The mortality associated with ANE is as high as 30%.6 There have been no recommended therapies for ANE.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2020-235264