title: Acute necrotizing encephalopathy causing human bocavirus.
abstract: Acute necrotizing encephalopathy is characterized by multiple, symmetrical lesions involving the thalamus, brainstem, cerebellum, and white matter and develops secondarily to viral infections. Influenza viruses are the most common etiological agents. Here, we present the first case of acute necrotizing encephalopathy to develop secondarily to human bocavirus. A 3-year-old girl presented with fever and altered mental status. She had had a fever, cough, and rhinorrhea for five days. The patient was admitted to the intensive care unit with an initial diagnosis of encephalitis when vomiting, convulsions, and loss of consciousness developed. Signs of meningeal irritation were detected upon physical examination. There was a mild increase in proteins, but no cells, in the cerebrospinal fluid (CSF). Brain magnetic resonance imaging showed symmetrical, heterogeneous hyperintensities bilaterally in the caudate nuclei and putamen. Ammonium, lactate, tandem mass spectroscopy, and urine organic acid were normal. No bacteria were detected in the CSF cultures. Human bocavirus was detected in a nasopharyngeal aspirate using real-time PCR, while no influenza was detected. Oseltamivir, acyclovir, 3% hypertonic saline solution, and supportive care were used to treat the patient, who was discharged after two weeks. She began to walk and talk after one month of physical therapy and complete recovery was observed after six months. Human bocavirus is a recently identified virus that is mainly reported as a causative agent in respiratory tract infections. Here, we present a case of influenza-like acute necrotizing encephalopathy secondary to human bocavirus infection.
authors.affiliation: 1 Kayseri Training and Research Hospital, Department of Pediatric Intensive Care Unit, Turkey.
authors.forename: Ayse Betul
authors.initials: AB
authors.lastname: Ergul
authors.affiliation: 1 Kayseri Training and Research Hospital, Department of Pediatric Intensive Care Unit, Turkey.
authors.forename: Umit
authors.initials: U
authors.lastname: Altug
authors.affiliation: 2 Gazi University Medical Faculty, Department of Pediatric Neurology, Turkey.
authors.forename: Kursad
authors.initials: K
authors.lastname: Aydin
authors.affiliation: 3 Kayseri Training and Research Hospital, Department of Pediatric Neurology, Turkey.
authors.forename: Ahmet Sami
authors.initials: AS
authors.lastname: Guven
authors.affiliation: 4 Kayseri Training and Research Hospital, Department of Pediatric Hematology, Turkey.
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Altuner Torun
mesh_terms: D002421:Caudate Nucleus / Q000000981:diagnostic imaging; D002675:Child, Preschool; D005260:Female; D056661:Human bocavirus / Q000472:pathogenicity*; D006801:Humans; D004684:Leukoencephalitis, Acute Hemorrhagic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000821:virology*; D008279:Magnetic Resonance Imaging; D011699:Putamen / Q000000981:diagnostic imaging
keywords: Acute necrotizing encephalopathy; basal ganglion; child; human bocavirus