Acute Hemorrhagic Encephalopathy (AHE) in a 21 Year Old Patient With Influenza A Viral Infection
Objective:
To review the aggressive potential for Influenza A to cause multi-system organ failure, including rapid neurological decompensation.
Background:
A previously healthy 21 year old man was admitted with overwhelming H3 subtype Influenza A infection. He had progressive multisystem organ failure, developed acute respiratory distress syndrome (ARDS) and difficulty with mechanical ventilation that required veno-arterial extracorporeal membrane oxygenation (VA-ECMO) initiation. His course was complicated by toxic shock syndrome. Extensive work up failed to identify evidence of bacterial super-infection except for group A strep in the lungs.
Design/Methods:
Single patient chart review
Results:
Our patient developed multicompartmental hemorrhages and diffuse cerebral edema several days into his course, without evidence of a central embolic source on extensive work up, raising concern for acute hemorrhagic encephalitis (AHE). He remained too unstable for MRI for further characterization. Following an episode of severe hypoxia and hypotension that caused a superimposed hypoxic ischemic brain injury, he lost all brainstem reflexes and progressed to brain death.
Conclusions:
Influenza A is a highly mutable RNA virus from the Orthomyxoviridae family, and typically presents with upper respiratory tract infections. However, it has occasionally been shown to lead to severe complications, including secondary bacterial infections, widespread inflammatory reactions, and acute hemorrhagic encephalitis. AHE can be seen in patients with severe infection and is associated with devastating neurologic outcomes. Patients develop hemorrhagic necrotizing parenchymal changes on neuro-imaging, with rapidly worsening encephalopathy and coma within the first two weeks of illness. The pathophysiology of this syndrome is hypothesized to occur due to direct viral-mediated endotheliopathy, cytokine storm and blood-brain-barrier dysfunction.
This case highlights the importance of recognizing this rare yet devastating neurological complication and maintaining a low threshold for brain imaging in patients with overwhelming Influenza infection and altered mental status.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.