A case report ofAcute Necrotizing Encephalopathy in a Child

A 2-year-old girl, previously developmentally normal, was brought to the hospital with a 5-day history of fever, 7 episodes of loose stools per day for 3 days, and three brief generalized tonic-clonic seizures, accompanied by encephalopathy and a Glasgow coma scale (GCS) of 9/15. She was initially treated with ceftriaxone, amikacin, acyclovir, and levetiracetam. Laboratory tests showed elevated transaminases, ESR, and CRP, while serologies for various viruses were negative, and CSF analysis was normal. An MRI conducted on the second day of admission revealed bilateral thalamic hyperintensities with a 'double doughnut' and 'tricolor' pattern. The patient was treated with intravenous immunoglobulin (IVIG) and methylprednisolone and was discharged on day 7. Follow-up at two weeks showed her neurological examination to be unremarkable, with regained ability to walk, understand commands, and speak.

The case highlights the case of acute necrotizing encephalopathy (ANE), a fulminant, parainfectiousclinico-radiological syndrome typically showing poor recovery rates. The condition is associated with cytokine storms due to viral infections and is characterized by specific neuroimaging findings such as bilateral lesions in the thalamus. Poor outcomes are linked with factors such as multiorgan dysfunction, low GCS at admission, and MRI findings.

Source:Bhanudeep S, Koneti B.B. Successful Management of Acute Necrotizing Encephalopathy in a Child. Indian J Pediatr. 2025;92(98). https://doi.org/10.1007/s12098-024-05306-8