Status Epilepticus, Encephalopathy and Punctate Infarcts in a Patient with Influenza A: An Atypical Presentation of Influenza-Associated Encephalopathy

Influenza-associated encephalopathy is a rare complication of influenza virus infection in pediatric patients. Manifestations include changes in mental status, seizures, and acute necrotizing encephalopathy, a clinical entity characterized by prominent, severe neurological symptoms and abnormal neuroimaging. It is not well described how these presentations differ from and interact with other inflammatory syndromes triggered by influenza (including HLH). Moreover, with the increasing use of nicotine and marijuana in the pediatric population, presentations of influenza-associated encephalopathy could be influenced by chronic changes caused by neuroactive substances as well as underlying neurological disease. Here we describe a severe neurological presentation in a pediatric patient in the setting of influenza infection, with features suggestive of acute necrotizing encephalitis (ANE) with atypical neuroimaging features. She also showed evidence of systemic inflammation, including cardiomyopathy, hepatitis, coagulopathy, and acute kidney injury. This presentation was superimposed on a background of chronic e-cigarette use and concern for an underlying seizure disorder. Our report broadens the reported range of influenza-associated encephalopathy in patients with neurological vulnerabilities.