A case of acute necrotizing encephalopathy associated with parainfluenza virus infection

Abstract

Acute necrotizing encephalopathy (ANE) may be suspected when a young child presents with abrupt onset of altered mental status, seizures, or both. Definitive clinical diagnosis is based on magnetic resonance imaging (MRI) results. ANE is associated with influenza virus infections. Preliminary data suggests that up to 25% of ANE patients die, and up to 25% of ANE survivors develop substantial neurologic sequelae. Here, we describe a case of a comatose 22-month-old girl who was admitted to our hospital because of febrile illness and seizures. On day 13 of her illness, she died from ANE associated with infection from parainfluenza virus. Brain MRI results indicated diffuse bilateral symmetric signal changes in both basal ganglia, thalami, periventricular white matter, pons, and cerebral white matter, as well as generalized swelling of the brain.

Neurological Complications of Novel Influenza A (H1N1) pdm09 Infection: Report of Two Cases and a Systematic Review of the Literature

“…Laboratory findings in ANE include deranged liver enzymes, increased renal parameters, hypoproteinemia, and abnormal CSF analysis [15]. Neuroimaging usually demonstrates multifocal bilateral periventricular white matter, thalamic, brain stem, or cerebellar changes [16]. On pathology, affected areas of the brain are characterized by the presence of hemorrhages and necrosis [12].…”

Acute Necrotizing Encephalopathy: An Underrecognized Clinicoradiologic Disorder

“…Comparisons of the clinical features between Asian and non-Asian patients revealed homogeneity of the disease worldwide [ 12 ]. In addition to prodromal symptoms due to different viral infections, which include fever, signs of upper respiratory tract infections and gastroenteritis, and erythema, patients with ANE often have signs of SIRS like shock, multiple organ failure (MOF), and disseminated intravascular coagulation (DIC) [ 17 , 33 , 56 ]. With the development of ANE, brain dysfunctions may present as seizures, disturbance of consciousness, and focal neurological deficits [ 3 , 17 – 26 , 57 ].…”

Severe acute encephalopathy related to human parainfluenza virus type 2 infection in an infant: a case report

“…Recently, several extra-pulmonary symptoms caused by respiratory viruses have been reported (Eisenhut, 2006;Kim & You, 2012;Miyamoto et al, 2013;Abenhaim Halpern et al, 2013). RSV infections affecting other organs have been reported (Miyamoto et al, 2013), with the RSV antigen detected in the CSF, myocardium, liver and peripheral blood.…”

“…Recently, several cases of acute encephalopathy related to HPIV have been reported, especially in Asian countries (Kim & You, 2012;Abenhaim Halpern et al, 2013). In these reports, HPIV was detected from patients' nasal swabs.…”

“…Human parainfluenza viruses (HPIVs) are respiratory viruses that commonly cause respiratory infections in children (Henrickson, 2003). In recent years, the importance of extra-pulmonary symptoms of HPIV infection has become evident, and severe cases of HPIV-related encephalitis have been reported (Kim & You, 2012;Abenhaim Halpern et al, 2013).…”