title: A severe neurological complication of influenza in a previously well child.
abstract: We describe a case of a 3-year-old girl who was admitted with encephalopathy and a right-sided hemiparesis secondary to acute influenza A. She was up-to-date with the Australian National Immunisation Program (which does not routinely include the seasonal influenza vaccine). After initial treatment with intravenous antimicrobials and acyclovir, a brain and spinal cord MRI demonstrated extensive focal necrotic and haemorrhagic changes in keeping with acute necrotising encephalopathy (ANE). She was started on a course of oseltamivir and intravenous pulse methylprednisolone, followed by an oral weaning regimen of prednisolone. After an intense period of rehabilitation, she has made a remarkable recovery. Genetic testing has since confirmed that this girl has the RANBP2 gene mutation, which leads to increased susceptibility of developing ANE. This case report highlights ANE as a rare but severe complication of influenza, the unfortunate complication of having the RANBP2 mutation and the importance of paediatric influenza vaccination.
authors.affiliation: Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Philippa
authors.initials: P
authors.lastname: McSwiney
authors.affiliation: The Northern Hospital, Melbourne, Victoria, Australia.
authors.forename: Jessica
authors.initials: J
authors.lastname: Purnama
authors.affiliation: Department of Neurology, The Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kornberg
authors.affiliation: Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Margie
authors.initials: M
authors.lastname: Danchin
mesh_terms: D001315:Australia; D001921:Brain / Q000473:pathology; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D009980:Influenza A virus; D007251:Influenza, Human / Q000150:complications*; D004684:Leukoencephalitis, Acute Hemorrhagic / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D053139:Oseltamivir / Q000627:therapeutic use; D010291:Paresis / Q000209:etiology; D011239:Prednisolone / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D053139:Oseltamivir; D011239:Prednisolone