Influenza A Encephalitis in an Adult Patient

Abstract

Abstract A 45-year-old woman presented with 7 days of worsening dyspnea, nonproductive cough, myalgias, and chills. The following day, the patient had acute respiratory failure, requiring mechanical ventilation, and eventually developed acute respiratory distress syndrome. Respiratory panel tested positive for influenza A. The patient's mental status progressively worsened to coma. Magnetic resonance imaging of the brain demonstrated relatively symmetrical bilateral T2 FLAIR abnormalities in the thalami, corpus callosum, pons, and cerebellum. Cerebrospinal fluid polymerase chain reaction was positive for influenza A. The patient was transitioned to high-dose oseltamivir and high-dose corticosteroids. Repeat magnetic resonance imaging demonstrated gross resolution of T2 FLAIR abnormalities. The patient's mental status continued to improve daily. At the time of discharge, 30 days after symptom onset, the patient was awake and following commands. Six months after hospitalization, the patient had successfully been able to return to her baseline function except for right homonymous quadrantanopia and some mild residual left upper extremity weakness.