P0619 / #1524: ACUTE NECROTIZING ENCEPHALOPATHY (ANE) RELATED TO INFLUENZA AND MYCOPLASMA PNEUMONIAE IN A CHILD

Abstract

Aims & Objectives: Background: ANE is a rare neurologic complication of influenza which lead to profound disability or death.The co-infection role of M. pneumoniae on this condition has not been previously reported. Aims: Clinical case presentation. Methods: Methodology: Chart review and literature search. Results: A previously healthy 5-year-old female, 3 hours before admission presents with fever, restlessness, and an involuntary bowel movement. She became confused and developed right hemiparesis and dysarthria. Soon after arrival to the ER, she developed right-sided clonic seizures, coma, bilateral areactive mydriasis with no corneal reflex, and hypotension. An admission brain-CT (Fig. 1)scan reported no intracranial abnormalities, but a MRI (Fig. 2), performed 2 hours after stabilization, reported diffuse hyperintensity with cytotoxic edema in cerebellar hemispheres, posterior brainstem, thalamus, basal ganglia, gray and white supra and infratentorial substance, findings consistent with ANE. Despite decompressive craniotomy and maximum therapeutic efforts, intracranial hypertension was severe and refractory to treatment. A PCR respiratory panel was positive for Influenza A/H1-2009, A/H1-pan, A/pan1, A/pan2 and M. pneumoniae. Blood and urine cultures were negative. A CT scan after 12 hours reported total obliteration of the CSF spaces, occipital transcranial herniation, and absence of intracranial circulation. The patient died after 36 hours. A post-mortem CSF analysis, including a PCR panel and culture, were negative.Conclusions: ANE is a consequence of an inappropriate immune response to virus and bacteria associated with poor outcomes or severe complications. More research is needed to stablish an association with a genetic predisposition.