Galan Fernando, Nordli Douglas R, Yazdani Milad, Klein Jessica
Medical University of South Carolina, Charleston, SC, USA.
Nemours Children's Health, Jacksonville, FL, USA.
Child Neurol Open. 2022 Dec 13;9:2329048X221143689. doi: 10.1177/2329048X221143689. eCollection 2022 Jan-Dec.
In current literature, there is uncertainty in the pathophysiology and management of influenza-associated Acute Necrotizing Encephalitis. Because of this and the rarity of the disease, no clear treatment guidelines exist. It is thought that treatment after 24 h of symptom onset or known brainstem involvement are poor predictors of outcome. Here, we present a case that provides support for aggressive management of the inflammatory cascade with combination high-dose steroid, immunoglobulin, and anti-viral therapy with oseltamivir despite initiation after 24 h from symptom onset, brainstem involvement, and a pathogenic gene mutation which mechanistically increases oxidative stress, cytokine effects, and possibly viral invasion into brain tissue and vasculature.
在当前的文献中，流感相关急性坏死性脑病的病理生理学和治疗存在不确定性。由于这一点以及该疾病的罕见性，目前尚无明确的治疗指南。据认为，症状出现24小时后或已知脑干受累后进行治疗，对预后的预测效果不佳。在此，我们报告一例病例，该病例支持尽管在症状出现24小时后、出现脑干受累以及存在一种机制性增加氧化应激、细胞因子作用并可能增加病毒侵入脑组织和血管的致病基因突变的情况下，仍采用大剂量类固醇、免疫球蛋白联合奥司他韦抗病毒治疗对炎症级联反应进行积极管理。
