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Severe Acute Disseminated Encephalomyelitis Following Swine Influenza Virus (H1N1) Infection in Children

Khair AM, Elsotouhy A, Elmagrabi D, Ibrahim K

Background: Neurological complications of influenza viral infection have rarely been discussed in current literature. In the era of recent outbreaks of this potentially serious viral illness, understanding of possible extrapulmonary clinical manifestations is crucially needed.

Case report: We are reporting two toddler girls who have been endorsed as previously healthy. Both patients have presented with a febrile respiratory illness followed by severe encephalopathy needing intensive care unit admission. They have been found to have novel H1N1 infection. Their neuroimaging studies were consistent with severe acute disseminated encephalomyelitis (ADEM). Good response to immunotherapy has been luckily achieved.

Discussion: ADEM is an acute autoimmune encephalopathy disease which is commonly triggered by viral illnesses. However, particular correlation with novel H1N1 viral infection is not well described. Whether H1N1 triggers more severe clinical and radiological variant of ADEM is not yet precisely known, though has been observed in our study. Current knowledge in regard to neurological burden of H1N1 infection is reviewed.

Conclusion: It is likely that H1N1 can trigger a more severe form of ADEM in children. Early suspicion and isolation of H1N1 virus in children who present with acute unexplained encephalopathy in the context of any viral illness seems to be a recommended practice.