Abstract
Two girls--Case 1 aged 4 and Case 2 aged 5--were admitted due to sudden onset of fever, disturbed consciousness, and convulsions. On admission, laboratory and hematological data in both cases was normal, although AST, ALT, LDH and CPK were markedly increased with conspicuously depressed platelet counts within 36hr of admission. Both had common symptoms of high fever(>40°C), bleeding, and hemorrhagic shock. Plasma exchange was conducted on days 2 and 3 for Case 1, but she died on day 9 after admission due to brain edema. Case 2 died on day 2 after admission due to hemorrhagic shock. Both had inflammation of the upper respiratory tract and influenza virus detected from pharyngeal swabs. Clinical and laboratory findings are compatible with hemorrhagic shock and encephalopathy syndrome (HSES). Its etiology in unknown and the outcome is often fatal or associated with severe neurological sequelae despite intensive treatment. The relationship between influenza virus infection and HSES is currently unknown and should be examined in future studies.
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