Abstract

The 2009 H1N1 pandemic strain of influenza A(H1N1)pdm09 was first detected in Mexico and the United States in the spring of 2009 and, thereafter, spread to across the world. In Japan, the number of patients affected by the virus increased dramatically since September 2009.1 The clinical profile of (H1N1)pdm09 infection varies from asymptomatic or mild to severe cases, resulting in severe respiratory failure, encephalitis or encephalopathy, and death in the worst scenario.2 Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder of the central nervous system following a viral infection or vaccination. The pathogenesis of ADEM is proposed to be autoimmune mechanisms triggered by infectious agents or vaccines. Childhood ADEM occurs more often after infection, and its prognosis is considered to be generally favorable.3 There are several reports of severe pneumonia caused by (H1N1)pdm09 infection, while there are only 7 pediatric case reports of ADEM following (H1N1)pdm09 until recently: none of these cases were complicated by pneumonia.4-6 Here we describe the case of 5-year-old boy who developed ADEM secondary to (H1N1)pdm09 severe pneumonia. To the best of our knowledge, this is the first case report of a pediatric patient with both comorbidities.

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