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Case report
Influenza A-associated acute necrotising encephalopathy in a 10-year-old child
  1. Patricia JLT Sanders1,
  2. Dick A van Waardenburg1 and
  3. R Jeroen Vermeulen2
  1. 1Pediatric Intensive Care Unit, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
  2. 2Neurology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
  1. Correspondence to Patricia JLT Sanders; patricia.sanders{at}


We report an otherwise healthy 10-year-old boy who was brought to the emergency department with altered mental status, vomiting, diarrhoea and fever (39.5°C), without signs of meningitis. The CT scan revealed bilateral hypodensities of the thalamus and cerebellum, with diffuse oedema and slight compression of the brainstem and a triventricular hydrocephalus. Lumbar puncture and blood examination revealed markedly elevated protein level of 2.4 g/L in cerebrospinal fluid and high serum aminotransferase, characteristic of acute necrotising encephalopathy (ANE). The PCR of the nasopharyngeal swab was influenza A positive. Because of signs of high intracranial pressure, mannitol was given, an external ventricular drain was placed and subsequently, a posterior fossa craniectomy was performed. Postoperatively, he showed signs of cerebellar mutism with emotional instability and diminished speech. Six months after presentation, he showed full recovery. This case illustrates ANE as a rare complication of influenza A infection.

  • influenza
  • paediatric intensive care
  • coma and raised intracranial pressure
  • infection (neurology)

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  • Contributors PS wrote the case report, and DvW and JV reviewed the manuscript and were both actively involved during the admission in the paediatric ICU.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.