A Case of ALERD Masquerading as Paracetamol Poisoning

Asif Mahaldar,Prakash Vj,Prashant Teggi,Shankargouda V Patil,Siddarameshwar S Kalyanshettar

doi:10.3126/jnps.v40i3.29728

Asif Mahaldar, Prakash Vj + Show 3 more

Open Access

https://doi.org/10.3126/jnps.v40i3.29728

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Abstract

ALERD (Acute leukoencephalopathy with restricted diffusion) is a clinico – radiological diagnosis. Many novel causes of acute encephalopathy are emerging in children. MRI plays an important role in the diagnosis and management of such children. Many infectious and non-infectious conditions and poisonings are known to precipitate acute leukoencephalopathy. A commonly used drug like paracetamol ingested in large quantities is known to cause varied effects. We describe one such child who presented to us with paracetamol poisoning and developed acute leukoencephalopathy. He was later found to have restricted diffusion on magnetic resonance imaging.

Highlights

Acute encephalopathy in children can have varied etiologies like infections and non-infectious causes including poisonings
Acute leukoencephalopathy with restricted diffusion is a clinico – radiological diagnosis, which is being increasingly reported in recent years
MRI plays an important role in the diagnosis and management of such children. We describe one such child who presented to us with paracetamol poisoning and developed acute leukoencephalopathy subsequently and was found to have restricted diffusion on magnetic resonance imaging

Summary

INTRODUCTION

Acute encephalopathy in children can have varied etiologies like infections and non-infectious causes including poisonings. MRI plays an important role in the diagnosis and management of such children. We describe one such child who presented to us with paracetamol poisoning and developed acute leukoencephalopathy subsequently and was found to have restricted diffusion on magnetic resonance imaging. On second day of admission, child developed sudden onset respiratory distress and required ventilator support in view of poor respiratory efforts & dipping oxygen saturation. Child’s sensorium worsened gradually and required ventilator support for further two days. On fifth day of admission patient could be weaned off ventilator and second anticonvulsant oxcarbazepine was started in view of recurrent convulsions. Sensorium improved further and child tolerated full oral feeds from tenth day. Child was discharged on fifteenth day with oral cyclosporin, dextromethorphan and oxcarbazepine. At discharge child was conscious and hearing normally but had cortical blindness

DISCUSSION

CONCLUSIONS