Lee Yu-Jin, Smith D Scott, Rao Vivek A, Siegel Robert D, Kosek Jon, Glaser Carol A, Flint Alexander C
Department of Human Biology, Stanford University, Stanford, CA 94305, USA.
Department of Infectious Disease and Geographic Medicine, Kaiser Permanente, Redwood City, CA 94063, USA.
Case Rep Crit Care. 2011;2011:562516. doi: 10.1155/2011/562516. Epub 2011 Jul 5.
Acute necrotizing encephalopathy (ANE) is a severe neurological complication of influenza infection, including H1N1 influenza. Many cases of ANE have been reported in the pediatric literature, but very few cases have been described in adults. The cause of ANE remains unknown-the influenza virus is not known to be neurotropic, and evidence of direct viral involvement of the central nervous system (CNS) has not been demonstrated in the limited cases of ANE in which pathological specimens have been obtained. Here we report a fatal case of ANE from H1N1 influenza infection in an adult. Neuroimaging and postmortem analysis both showed widespread brain edema, necrosis, and hemorrhage, but molecular studies and postmortem pathology revealed no evidence of direct viral involvement of the CNS. This case of fatal ANE in an adult is consistent with the hypothesis generated from pediatric cases that the host immune response, and not direct viral invasion of the CNS, is responsible for pathogenesis of ANE.
急性坏死性脑病（ANE）是流感感染（包括H1N1流感）的一种严重神经并发症。儿科文献中已报道了许多ANE病例，但成人病例描述很少。ANE的病因尚不清楚——流感病毒不具有嗜神经性，在已获取病理标本的有限ANE病例中，尚未证实中枢神经系统（CNS）有病毒直接参与的证据。在此，我们报告一例成人因H1N1流感感染导致的致命性ANE病例。神经影像学和尸检分析均显示广泛的脑水肿、坏死和出血，但分子研究和尸检病理学未发现CNS有病毒直接参与的证据。这例成人致命性ANE病例与儿科病例提出的假说一致，即ANE的发病机制是由宿主免疫反应而非病毒直接侵袭CNS所致。
