Acute Necrotizing Encephalopathy Associated With Parainfluenza Virus in a Caucasian Child

Abstract

Acute necrotizing encephalopathy is a severe parainfectious disorder with a clear racial predilection for Oriental children living in the Far East. The prognosis was originally reported as grave; however, a mild form of the disease has recently been described. A case of parainfluenza virus-associated acute necrotizing encephalopathy in a Caucasian child with a mild clinical course and excellent prognosis is presented. In this patient, the initial clinical picture was not very impressive, and the diagnosis was delayed until the third week of the illness, when neuroimaging was performed. Two months later, clinical and neuroimaging findings had almost completely resolved. Suggested criteria for a benign prognosis, such as normal liver function and cerebrospinal fluid protein levels, asymmetric thalamic lesions, and no brainstem involvement, were relevant in the present case. An extended diagnostic work-up for metabolic, vascular, coagulation, and infectious diseases was negative apart from a seroconversion for parainfluenza virus. To our knowledge, this is the first reported case of acute necrotizing encephalopathy associated with parainfluenza virus infection. Acute necrotizing encephalopathy, especially in the mild form, might not be fully recognized and could be underdiagnosed in Europe, where the reported incidence of the syndrome is very low.

Influenza A virus-associated acute necrotizing encephalopathy in the United States

“…Acute necrotizing encephalopathy, first described in 1995 by Mizuguchi et al, 2 has been linked to influenza, as well as other infectious illnesses such as with HHV-6 4 measles, 5 parainfluenza virus 6 and Mycoplasma. 7 The hallmark of this type of encephalopathy is multifocal, symmetric brain lesions affecting the thalamus bilaterally, brainstem tegumentum, cerebral periventricular white matter and cerebellar medulla, which can be visualized best by MRI.…”

A case of acute necrotizing encephalopathy associated with parainfluenza virus infection

“…ANE appears to be most common in Asian children, but there is a previous report of this disorder in a Caucasian child3). In the present case report, we describe a Korean child with ANE associated with parainfluenza virus infection.…”

“…ANE is a rare disease firstly described by Mizuguchi et al1), which affects young children in Far East countries, mainly Japan and Taiwan2), and recently also in North America and Europe3-5). The clinical characteristics of this disorder are encephalopathy soon after a febrile illness, elevation of serum aminotransferase1,2), diffuse, bilateral, symmetric high intensity signal on T2-weighted brain magnetic resonance imaging (MRI), edema, and apoptosis and necrosis of neurons without inflammation evident in brain microscopy.…”

Isolation of novel bovine parainfluenza virus type 5 (bPIV5) and its incidence in Korean cattle

“…Previous researcher reported that coinfection with viral or environmental factors may contribute to the virulence of pPIV5 exacerbating the clinical symptoms of disease [13]. In addition, it is also noted that children with human parainfluenza virus infection had brain legions compatible with acute necrotizing encephalopathy [14]. As mentioned above, bPIV5 alone or mixed with bacterial or viral pathogens such as Clostridium botulinum, BVDV, BRSV may also have acted as trigger for neurologic symptoms in cattle.…”