A toddler boy presented with fever, rhinitis and loose stools, followed by two episodes of generalised seizures with up-rolling of eyes and posturing. Initially the case was managed as febrile seizures. Later he developed progressive encephalopathy, dystonia and persistent seizures, requiring Paediatric Intensive Care Unit admission and mechanical ventilation. Neurological examination revealed hypertonia, exaggerated reflexes and a Glasgow Coma Score of 6, without signs of meningeal irritation. Laboratory investigations showed thrombocytopenia, leucopenia and transaminitis. H1N1 influenza A was detected via nasopharyngeal swab. CSF was normal; viral panel and metabolic workup were negative. MRI brain revealed hallmark features of Acute Necrotizing Encephalopathy of Childhood (ANEC). The child was treated with antiepileptics, high-dose steroids, intravenous immunoglobulin and supportive care. Gradual neurological improvement was noted with residual mild hypertonia managed through physiotherapy. This case highlights the importance of early recognition and aggressive management of influenza-associated ANEC to improve outcomes.
S et al. (Fri,) studied this question.