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Influenza A-associated acute necrotising encephalopathy
  1. Hawraman Ramadan1,
  2. Ibrahim Hassan2,
  3. Reham Elgafy3,
  4. Souhel Najjar4
  1. 1Neurology, The View Hospital, Doha, Qatar
  2. 2Critical Care, Hamad Medical Corporation, Doha, Qatar
  3. 3Rehabilitation, The View Hospital, Doha, Qatar
  4. 4Department of Neurology, Lenox Hill Hospital, New York, New York, USA
  1. Correspondence to Dr Hawraman Ramadan; h.ramadan{at}theviewhospital.com

https://doi.org/10.1136/pn-2024-004249

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    A previously healthy woman in her 20s was brought to the emergency department with a convulsive seizure. Over the preceding 24 hours, she had developed flu-like symptoms, including cough, headache and fever (39°C). She was started on lorazepam with a loading dose of levetiracetam and given empirical intravenous acyclovir and ceftriaxone. A CT scan of the head and blood tests for inflammatory markers, full blood count and renal and liver profile were normal. She was intubated and admitted to the medical intensive care unit due to a persistently low Glasgow coma scale score (7–8) and recurrent seizures. Cerebrospinal fluid (CSF) examination showed two white cells/µL (≤5), glucose 4.06 mmol/L (2.5–4.4) and protein 0.96 g/L (0.15–0.45); Gram stain, culture, viral PCR panel and cytology were negative. Electroencephalogram showed severe diffuse theta-delta slowing consistent with encephalopathy. A nasopharyngeal swab tested positive for influenza A, H3N2 subtype. Blood and …

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    Footnotes

    • Contributors All authors were involved in the care of the patient. HR executed and wrote the first and revised draft and submitted. SN provided expert advice, reviewed, critiqued and edited the manuscript. IH and EE reviewed the manuscript. All authors approved the final version of this manuscript. HR is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed by Nick Davies, London, UK.

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