1
|
Huang L, Li J. Bilateral Thalamic Lesions in an Infant With Viral Encephalitis. Clin Pediatr (Phila) 2024; 63:158-161. [PMID: 37559359 DOI: 10.1177/00099228231191932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Affiliation(s)
- Lilin Huang
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jing Li
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, China
| |
Collapse
|
2
|
Weisheng H, Hui Z, Shuang W, Qing G, Tianying S, Chenguang Y, Hongmei D. A sudden death due to acute necrotizing encephalopathy associated with influenza A virus infection: An autopsy case report. Leg Med (Tokyo) 2022; 58:102098. [PMID: 35662069 DOI: 10.1016/j.legalmed.2022.102098] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/18/2022] [Accepted: 05/27/2022] [Indexed: 11/25/2022]
Abstract
Influenza occasionally causes central nervous system disorders. Acute necrotizing encephalopathy (ANE) is one of the most severe influenza-associated complications, predominantly affecting infants and young children under 5 years of age. We present this case as it involves a very rare complication of influenza infection that is known to have a high rate of mortality. A 5-year-old girl presented with a high fever and convulsions. Her condition deteriorated rapidly, and she died within 24 h. Autopsy revealed extensive brain edema, multifocal perivascular hemorrhage, and necrosis of neurons without inflammatory cell infiltration in the pons and bilateral thalamus. Tests for influenza virus A and antibodies to it were positive. The girl's death was attributed to ANE associated with influenza A infection based on the clinical presentation, the postmortem neuropathology, and identification of the virus. The goal of this report is to draw attention to the potentially serious complications of influenza A infection. We hope that the lethal outcome of this disease will be fully recognized by medical personnel.
Collapse
Affiliation(s)
- Huang Weisheng
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Hankou, Wuhan, PR China
| | - Zhang Hui
- Central Laboratory, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, China
| | - Wu Shuang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Gao Qing
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Hankou, Wuhan, PR China
| | - Sun Tianying
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Hankou, Wuhan, PR China
| | - Yang Chenguang
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Hankou, Wuhan, PR China
| | - Dong Hongmei
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Hankou, Wuhan, PR China.
| |
Collapse
|
3
|
Chen Y, Fang B, Hu X, Guo R, Guo J, Fang K, Ni J, Li W, Qian S, Hao C. Identification and functional analysis of novel SLC25A19 variants causing thiamine metabolism dysfunction syndrome 4. Orphanet J Rare Dis 2021; 16:403. [PMID: 34587972 PMCID: PMC8480130 DOI: 10.1186/s13023-021-02028-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Thiamine metabolism dysfunction syndrome 4 (THMD4, OMIM #613710) is an autosomal recessive inherited disease caused by the deficiency of SLC25A19 that encodes the mitochondrial thiamine pyrophosphate (TPP) transporter. This disorder is characterized by bilateral striatal degradation and progressive polyneuropathy with the onset of fever of unknown origin. The limited number of reported cases and lack of functional annotation of related gene variants continue to limit diagnosis. Results We report three cases of encephalopathy from two unrelated pedigrees with basal ganglia signal changes after fever of unknown origin. To distinguish this from other types of encephalopathy, such as acute necrotizing encephalopathy, exome sequencing was performed, and four novel heterozygous variations, namely, c.169G>A (p.Ala57Thr), c.383C>T (p.Ala128Val), c.76G>A (p.Gly26Arg), and c.745T>A (p.Phe249Ile), were identified in SLC25A19. All variants were confirmed using Sanger sequencing. To determine the pathogenicity of these variants, functional studies were performed. We found that mitochondrial TPP levels were significantly decreased in the presence of SLC25A19 variants, indicating that TPP transport activities of mutated SLC25A19 proteins were impaired. Thus, combining clinical phenotype, genetic analysis, and functional studies, these variants were deemed as likely pathogenic. Conclusions Exome sequencing analysis enables molecular diagnosis as well as provides potential etiology. Further studies will enable the elucidation of SLC25A19 protein function. Our investigation supplied key molecular evidence for the precise diagnosis of and clinical decision-making for a rare disease.
Collapse
Affiliation(s)
- Yuanying Chen
- Beijing Key Laboratory for Genetics of Birth Defects, Beijing Pediatric Research Institute, MOE Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.,Henan Key Laboratory of Pediatric Inherited and Metabolic Diseases, Henan Children's Hospital, Zhengzhou Hospital of Beijing Children's Hospital, Zhengzhou, China
| | - Boliang Fang
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Xuyun Hu
- Beijing Key Laboratory for Genetics of Birth Defects, Beijing Pediatric Research Institute, MOE Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.,Henan Key Laboratory of Pediatric Inherited and Metabolic Diseases, Henan Children's Hospital, Zhengzhou Hospital of Beijing Children's Hospital, Zhengzhou, China
| | - Ruolan Guo
- Beijing Key Laboratory for Genetics of Birth Defects, Beijing Pediatric Research Institute, MOE Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.,Henan Key Laboratory of Pediatric Inherited and Metabolic Diseases, Henan Children's Hospital, Zhengzhou Hospital of Beijing Children's Hospital, Zhengzhou, China
| | - Jun Guo
- Beijing Key Laboratory for Genetics of Birth Defects, Beijing Pediatric Research Institute, MOE Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.,Henan Key Laboratory of Pediatric Inherited and Metabolic Diseases, Henan Children's Hospital, Zhengzhou Hospital of Beijing Children's Hospital, Zhengzhou, China
| | - Kenan Fang
- Pediatric Intensive Care Unit, Luoyang Maternal and Child Health Hospital, Luoyang, China
| | - Jingwen Ni
- Pediatric Intensive Care Unit, Luoyang Maternal and Child Health Hospital, Luoyang, China
| | - Wei Li
- Beijing Key Laboratory for Genetics of Birth Defects, Beijing Pediatric Research Institute, MOE Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.,Henan Key Laboratory of Pediatric Inherited and Metabolic Diseases, Henan Children's Hospital, Zhengzhou Hospital of Beijing Children's Hospital, Zhengzhou, China
| | - Suyun Qian
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
| | - Chanjuan Hao
- Beijing Key Laboratory for Genetics of Birth Defects, Beijing Pediatric Research Institute, MOE Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China. .,Henan Key Laboratory of Pediatric Inherited and Metabolic Diseases, Henan Children's Hospital, Zhengzhou Hospital of Beijing Children's Hospital, Zhengzhou, China.
| |
Collapse
|
4
|
Li S, Hu D, Li P, Xiao W, Li H, Liu G, Song Y, Ning S, Peng Q, Zhao D, Situ M, Li W, Wu P, Zheng J, Liu Y, Hu L, Wang P, Hu Z, Ma W, Shen J, Yang S. Parameters Indicating Development of Influenza-Associated Acute Necrotizing Encephalopathy: Experiences from a Single Center. Med Sci Monit 2021; 27:e930688. [PMID: 33934098 PMCID: PMC8101270 DOI: 10.12659/msm.930688] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Influenza-associated acute necrotizing encephalopathy (IANE) can be lethal and disabling and have a sudden onset and deteriorate rapidly but lacks early diagnostic indicators. We aimed to examine the early clinical diagnostic indicators in children with IANE. Material/Methods Acute influenza patients were grouped according to their clinical manifestations: flu alone (FA), flu with febrile seizure (FS), influenza-associated encephalopathy (IAE), and IANE. The clinical features, biomarkers, neuroelectrophysiological results, and neuroimaging examination results were compared. Results A total of 31 patients were included (FA (n=4), FS (n=8), IAE (n=14), and IANE (n=5)). The IANE group, whose mean age was 3.7 years, was more likely to show rapid-onset seizure, acute disturbance of consciousness (ADOC), Babinski’s sign, and death/sequela. More patients in the IANE group required tracheal intubation mechanical ventilation and received intravenous immunoglobulins (IVIG) and glucocorticoids. The alanine aminotransferase (ALT), aspartate transaminase (AST), and lactate dehydrogenase (LDH) levels in the IANE group were significantly higher than in the FS and IAE groups. The aquaporin-4 (AQP-4) antibody and malondialdehyde (MDA) levels in the serum and cerebrospinal fluid (CSF) were notably higher in IANE patients in the acute stage compared with FS and IAE patients. All patients in the IANE group had positive neuroimaging findings. Conclusions Early clinical warning factors for IANE include rapid-onset seizures in patients under 4 years of age, ADOC, and pathological signs. Increased AQP-4 antibodies and MDA levels in CSF might contribute to early diagnosis. Early magnetic resonance venography (MRV) and susceptibility-weighted imaging (SWI) sequences, or thrombelastography to identify deep vein thrombosis, might indicate clinical deterioration.
Collapse
Affiliation(s)
- Suyun Li
- Department of Pediatric Emergency Medicine, Guangzhou Women's and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Dandan Hu
- Department of Pediatric Neurology, Guangzhou Women's and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Peiqing Li
- Department of Pediatric Emergency Medicine, Guangzhou Women's and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Weiqiang Xiao
- Department of Radiology, Guangzhou Women's and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Huixian Li
- Data Statistics Center, Guangzhou Women's and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Guangming Liu
- Department of Pediatric Emergency Medicine, Guangzhou Women's and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Yongling Song
- Department of Pediatric Emergency Medicine, Guangzhou Women's and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Shuyao Ning
- Department of Pediatric Neurology, Guangzhou Women's and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Qiuyan Peng
- Department of Pediatric Emergency Medicine, Guangzhou Women's and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Danyang Zhao
- Department of Disease Control and Prevention, Guangzhou Women's and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Minxiong Situ
- Department of Disease Control and Prevention, Guangzhou Women's and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Wanqi Li
- Department of Pediatric Emergency Medicine, Guangzhou Women's and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Peiqun Wu
- Department of Pediatric Emergency Medicine, Guangzhou Women's and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Jipeng Zheng
- Department of Pediatric Emergency Medicine, Guangzhou Women's and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Yueting Liu
- Department of Pediatric Emergency Medicine, Guangzhou Women's and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Lin Hu
- Department of Pediatric Emergency Medicine, Guangzhou Women's and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Pengfei Wang
- Department of Pediatric Emergency Medicine, Guangzhou Women's and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Zhengbin Hu
- Department of Pediatric Emergency Medicine, Guangzhou Women's and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Wencheng Ma
- Department of Pediatric Emergency Medicine, Guangzhou Women's and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Jun Shen
- Department of Pediatric Emergency Medicine, Guangzhou Women's and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Sida Yang
- Department of Pediatric Neurology, Guangzhou Women's and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| |
Collapse
|
5
|
Taniguchi D, Nakajima S, Hayashida A, Kuroki T, Eguchi H, Machida Y, Hattori N, Miwa H. Deep cerebral venous thrombosis mimicking influenza-associated acute necrotizing encephalopathy: a case report. J Med Case Rep 2017; 11:281. [PMID: 28950885 PMCID: PMC5613462 DOI: 10.1186/s13256-017-1444-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 09/05/2017] [Indexed: 11/13/2022] Open
Abstract
Background Acute necrotizing encephalopathy is one of the most devastating neurological complications of influenza virus infection. Acute necrotizing encephalopathy preferentially affects the thalamus bilaterally, as does deep cerebral venous thrombosis, which can lead to misdiagnosis. Case presentation A 52-year-old Japanese woman infected with seasonal influenza B virus presented to the emergency care unit in our hospital with progressive alteration of her level of consciousness. Bilateral thalamic lesions were demonstrated by magnetic resonance imaging, leading to a tentative diagnosis of acute necrotizing encephalopathy. However, she had deep cerebral venous thrombosis, and the presence of diminished signal and enlargement of deep cerebral veins on T2*-weighted imaging contributed to a revised diagnosis of deep cerebral venous thrombosis. Anticoagulant therapy was initiated, leading to her gradual recovery, with recanalization of the deep venous system and straight sinus. Conclusions To the best of our knowledge, these results represent the first report of deep cerebral venous thrombosis associated with influenza infection. It is clinically important to recognize that deep cerebral venous thrombosis, although rare, might be one of the neurological complications of influenza infection. In the presence of bilateral thalamic lesions in patients with influenza infection, deep cerebral venous thrombosis should be considered in addition to acute necrotizing encephalopathy. Delays in diagnosis and commencement of anticoagulant therapy can lead to unfavorable outcomes.
Collapse
Affiliation(s)
- Daisuke Taniguchi
- Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, 177-8521, Tokyo, Nerima, Japan
| | - Sho Nakajima
- Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, 177-8521, Tokyo, Nerima, Japan
| | - Arisa Hayashida
- Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, 177-8521, Tokyo, Nerima, Japan
| | - Takuma Kuroki
- Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, 177-8521, Tokyo, Nerima, Japan
| | - Hiroto Eguchi
- Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, 177-8521, Tokyo, Nerima, Japan
| | - Yutaka Machida
- Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, 177-8521, Tokyo, Nerima, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, 1-21-1 Hongo, 113-0033, Bunkyo, Tokyo, Japan
| | - Hideto Miwa
- Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, 177-8521, Tokyo, Nerima, Japan.
| |
Collapse
|