A rare case of Reye's syndrome induced by influenza A virus with use of ibuprofen in an adult

Background

Reye's syndrome (RS) is a rare but severe acute life‐threating disease characterized by encephalopathy and fatty liver damage. Reye's syndrome is most common in children and rarely occurs in adults.

Case presentation

A 56‐year‐old woman was admitted to the emergency department with disturbance of consciousness and respiratory failure. She had taken ibuprofen for headache. Her Glasgow Coma Scale score was E3V3M5 on admission. The laboratory findings revealed acute liver failure with prothrombin time – international normalized ratio of 3.16, aspartate aminotransferase 12,548 IU/L, alanine aminotransferase 5,725 IU/L, and blood ammonia 102 μg/dL. Head magnetic resonance imaging showed hyperintense signals on diffusion‐weighed images of globus pallidus.

We diagnosed the patient with RS induced by influenza A and use of ibuprofen. The patient received supportive care in the intensive care unit and her clinical outcome was favorable.

Conclusion

Ibuprofen might be a risk factor for RS.

Neurologic aspects of influenza viruses

Although influenza A and B viruses are primarily known as respiratory viruses and mainly infected only the upper respiratory tract in humans, patients with influenza often develop signs and symptoms that are not due to the respiratory system. Frequently individuals with influenza develop headaches, meningismus, and even seizures in addition to their typical respiratory symptoms. In the past decades, influenza viruses have also been associated with serious non-respiratory signs. The famous 1918 strain of influenza was associated with von Economo's encephalitis lethargica and postencephalitic parkinsonism. In the 1960s influenza virus infections in children were associated with Reye's syndrome characterized often by fatty non-inflammatory hepatic disease and an encephalopathy with marked non-inflammatory cerebral edema. Intermittently children with influenza develop focal myalgia and myositis. Guillain–Barré syndrome was epidemiologically associated with the 1978 killed influenza vaccine but not subsequent vaccines. Although occasional children with influenza have developed encephalopathy, from 2000 through 2004 there was an increase in the number of serious cases of acute necrotizing encephalopathy accompanying infection with the influenza A 2009 strain. The current H5N1 strain of bird influenza occasionally infects humans with a high mortality rate and some appear to have central nervous signs. This chapter explores what is known about these influenza neurologic associations.