ABSTRACT 348

Abstract

Background and aims: Acute necrotising encephalopathy of childhood (ANEC) is a very rare disease. It is characterized with multifocal symmetrical and necrotic lesions in the central nervous system. The etiology and pathogenesis of this disease remain unknown. Influenza A virus, mycoplasma, herpes simplex virus, and human herpes virus-6 have been reported as common causative agents. The clinical features consist of hyperpyrexia, convulsions, recurrent vomiting, variable degrees of hepatic dysfunction and coma. The prognosis of ANEC is variable. We presented a 2 years 6 months old male with clinical and radiological findings of ANEC. Methods: CASE A 2.5 years-old boy was admitted to our hospital with fever, generalized tonic-clonic seizure and deterioration of consciousness. His CSF analysis was normal. On the second day, serum SGOT and SPOT levels elevated (7500 and 3350 U/L, respectively.) Brain MRI demostrated bilateral symmetrical signal changes of both talami, periventricular white matter, posterior part of internal cerebral pedincles, pontobulbar junction and left middle cerebral pedincle MRI also indicated cytotoxic edema. After injection of intravenous contrast matter, there was involvement on peripheral of thalamic lesions. These findings were related with ANEC. He was treated ceftriaxone, acyclovir, intravenous immunoglobulin and pulse methyl-prednisolone. Influenza A virus was detected by real time polymerase chain reaction test from nasopharyngeal swab and Oseltamivir was given. Conclusions: ANE is an uncommon neurological complication of acute infection in children and is to be further elucidated in many aspects. However, early diagnosis and appropriate treatment may lead to better neurological outcomes.