McSwiney Philippa, Purnama Jessica, Kornberg Andrew, Danchin Margie
Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.
The Northern Hospital, Melbourne, Victoria, Australia.
BMJ Case Rep. 2014 Oct 23;2014:bcr2014206930. doi: 10.1136/bcr-2014-206930.
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.
我们描述了一例3岁女孩的病例，她因甲型流感继发脑病和右侧偏瘫入院。她按照澳大利亚国家免疫规划程序接种了疫苗（该程序通常不包括季节性流感疫苗）。在最初接受静脉用抗菌药物和阿昔洛韦治疗后，脑部和脊髓MRI显示出广泛的局灶性坏死和出血性改变，符合急性坏死性脑病（ANE）。她开始接受奥司他韦治疗和静脉注射脉冲甲基强的松龙，随后是强的松龙口服减量方案。经过一段时间的强化康复治疗，她已取得显著恢复。基因检测后来证实，这个女孩存在RANBP2基因突变，这导致她患ANE的易感性增加。本病例报告强调了ANE作为流感罕见但严重的并发症、携带RANBP2突变的不幸后果以及儿童流感疫苗接种的重要性。
