Pediatric Intensive Care Unit, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
Pediatric Intensive Care Unit, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
BMJ Case Rep. 2020 Aug 25;13(8):e233541. doi: 10.1136/bcr-2019-233541.
We report an otherwise healthy 10-year-old boy who was brought to the emergency department with altered mental status, vomiting, diarrhoea and fever (39.5°C), without signs of meningitis. The CT scan revealed bilateral hypodensities of the thalamus and cerebellum, with diffuse oedema and slight compression of the brainstem and a triventricular hydrocephalus. Lumbar puncture and blood examination revealed markedly elevated protein level of 2.4 g/L in cerebrospinal fluid and high serum aminotransferase, characteristic of acute necrotising encephalopathy (ANE). The PCR of the nasopharyngeal swab was influenza A positive. Because of signs of high intracranial pressure, mannitol was given, an external ventricular drain was placed and subsequently, a posterior fossa craniectomy was performed. Postoperatively, he showed signs of cerebellar mutism with emotional instability and diminished speech. Six months after presentation, he showed full recovery. This case illustrates ANE as a rare complication of influenza A infection.
我们报告了一例无其他健康问题的 10 岁男孩，因精神状态改变、呕吐、腹泻和发热（39.5°C）而被带到急诊室，无脑膜炎迹象。CT 扫描显示丘脑和小脑双侧密度降低，伴有弥漫性水肿，脑干受压轻微，三脑室脑积水。腰椎穿刺和血液检查显示脑脊液中蛋白质水平明显升高，达到 2.4g/L，血清转氨酶升高，符合急性坏死性脑病（ANE）的特征。鼻咽拭子的 PCR 检测结果为甲型流感阳性。由于存在颅内压升高的迹象，给予甘露醇治疗，放置外部脑室引流管，随后进行后颅窝颅骨切除术。术后，他出现小脑缄默症的迹象，表现为情绪不稳定和言语减少。发病 6 个月后，他完全康复。本例说明 ANE 是甲型流感感染的罕见并发症。
