TY - JOUR
T1 - Excellent Outcome of Acute Necrotizing Encephalopathy in an Adult With Bacterial Infections, Case Report
AU - Wang, Yan
AU - Younce, John R.
AU - Perlmutter, Joel S.
AU - Mar, Soe S.
N1 - Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Dr. Younce reports funding by NIH grant 5T32NS00720530 (TOP-TIER). Dr. Perlmutter reports funding by grants from NINDS/NIA (NS075321); American Parkinson Disease Association (APDA) Advanced Research Center for PD at WUSTL; Greater St. Louis Chapter of the APDA; Barnes Jewish Hospital Foundation (Clinical Translational Research Award; Elliot Stein Family Fund; PD Research Fund) and the Jo Oertli fund.
Publisher Copyright:
© The Author(s) 2021.
PY - 2021/10
Y1 - 2021/10
N2 - Acute necrotizing encephalopathy (ANE) is a rare para-infectious encephalopathy that classically occurs in children. However, ANE should be considered in the differential diagnosis of adults with symmetric brain lesions after a prodromal illness given recent reports of coronavirus disease of 2019 (COVID-19) to presumably cause ANE in adults. We report a case of a 29-year-old male presenting with fever, malaise, and rapid deterioration into coma. Brain magnetic resonance imaging revealed multifocal symmetric areas of diffusion restriction and surrounding vasogenic edema involving bilateral thalami, pons and cerebellar hemispheres with a core of susceptibility artifact, and minimal thalamic contrast enhancement, most consistent with ANE. Extensive infectious workup revealed isolated Escherichia coli and Neisseria gonorrhoeae in his urine. Despite the severe encephalopathy on initial presentation, the patient improved with intravenous antibiotics and supportive management with minimal residual deficits at 9 months follow-up. We aim to provide an overview of the radiological features, differential diagnosis, treatment and prognosis of ANE. Becoming familiarized with this rare but devastating disease will improve detection, treatment, and ultimately prognosis, especially in the era of a new pandemic.
AB - Acute necrotizing encephalopathy (ANE) is a rare para-infectious encephalopathy that classically occurs in children. However, ANE should be considered in the differential diagnosis of adults with symmetric brain lesions after a prodromal illness given recent reports of coronavirus disease of 2019 (COVID-19) to presumably cause ANE in adults. We report a case of a 29-year-old male presenting with fever, malaise, and rapid deterioration into coma. Brain magnetic resonance imaging revealed multifocal symmetric areas of diffusion restriction and surrounding vasogenic edema involving bilateral thalami, pons and cerebellar hemispheres with a core of susceptibility artifact, and minimal thalamic contrast enhancement, most consistent with ANE. Extensive infectious workup revealed isolated Escherichia coli and Neisseria gonorrhoeae in his urine. Despite the severe encephalopathy on initial presentation, the patient improved with intravenous antibiotics and supportive management with minimal residual deficits at 9 months follow-up. We aim to provide an overview of the radiological features, differential diagnosis, treatment and prognosis of ANE. Becoming familiarized with this rare but devastating disease will improve detection, treatment, and ultimately prognosis, especially in the era of a new pandemic.
KW - MRI
KW - all immunology
KW - all infections
KW - case report
KW - post infectious
UR - http://www.scopus.com/inward/record.url?scp=85100500047&partnerID=8YFLogxK
U2 - 10.1177/1941874421991370
DO - 10.1177/1941874421991370
M3 - Article
C2 - 34567397
AN - SCOPUS:85100500047
SN - 1941-8744
VL - 11
SP - 351
EP - 355
JO - The Neurohospitalist
JF - The Neurohospitalist
IS - 4
ER -