[P2-24] Rapidly progressive acute encephalitis associated with influenza A, H1N1 infection
Introduction
Multiple cases of severe complications of influenza A (H1N1) infections have been reported. Neurological impairment with influenza infection is defined as influenza-associated encephalopathy (IAE), which is rare but lethal complication with seizure, altered mentality, and Reye’s syndrome. Here we describe a patient with influenza A (H1N1) infection presenting acute fatal encephalitis and combined liver failure.
Case
A 7-year-old boy presented with altered mentality after fever for a day. He was previously healthy and got influenza vaccination. To evaluate the cause of mental change and hyperthermia, spinal tapping for CSF analysis was performed but it did not reveal meningeal inflammation except markedly elevated CSF pressure. Laboratory test revealed marked elevation of liver enzyme (1069 IU/L of AST, 661 IU/L of ALT) and severe coagulopathy (17.3 % of PT, 104.9 sec of aPTT). Influenza A, H1N1 pandemic 2009 strain was identifed by PCR in this patient's nasopharyngeal aspiration specimen.
The following CT scan showed diffuse brain edema, however, surgical decompression was delayed due to prominent coagulopathy. Despite of the meticulous medical managements of increased intracranial pressure, brain edema progressed to trans-tentorial herniation in twelve hours and fulminant hepatic failure continued. Surgical decompression was not helpful at this moment and he was brain-dead at the next day of admission.
Conclusion/Discussion
H1N1 influenza infection should be considered in the differential diagnosis in patients with metal status changes, especially during an influenza outbreak.
Multiple cases of severe complications of influenza A (H1N1) infections have been reported. Neurological impairment with influenza infection is defined as influenza-associated encephalopathy (IAE), which is rare but lethal complication with seizure, altered mentality, and Reye’s syndrome. Here we describe a patient with influenza A (H1N1) infection presenting acute fatal encephalitis and combined liver failure.
Case
A 7-year-old boy presented with altered mentality after fever for a day. He was previously healthy and got influenza vaccination. To evaluate the cause of mental change and hyperthermia, spinal tapping for CSF analysis was performed but it did not reveal meningeal inflammation except markedly elevated CSF pressure. Laboratory test revealed marked elevation of liver enzyme (1069 IU/L of AST, 661 IU/L of ALT) and severe coagulopathy (17.3 % of PT, 104.9 sec of aPTT). Influenza A, H1N1 pandemic 2009 strain was identifed by PCR in this patient's nasopharyngeal aspiration specimen.
The following CT scan showed diffuse brain edema, however, surgical decompression was delayed due to prominent coagulopathy. Despite of the meticulous medical managements of increased intracranial pressure, brain edema progressed to trans-tentorial herniation in twelve hours and fulminant hepatic failure continued. Surgical decompression was not helpful at this moment and he was brain-dead at the next day of admission.
Conclusion/Discussion
H1N1 influenza infection should be considered in the differential diagnosis in patients with metal status changes, especially during an influenza outbreak.