Blindness Due to Severe Influenza B Infection: Case Report

Main Article Content

Federica Badía Emilia Alonso Mónica Pujadas Albertina Filardi Joaquina Goldara María Catalina  Pirez

Abstract

Introduction: Influenza is an acute febrile infectious disease with respiratory manifestations, in a variable degree of severity, and a seasonal epidemic distribution. In healthy children, it usually presents as mild and self-limiting, but it can evolve into severe forms with significant morbidity and mortality. These include neurological manifestations such as influenza-associated encephalopathy and acute necrotizing encephalopathy. Objective: To report case of a previously healthy child who developed severe pneumonia due to influenza B and subsequent blindness associated with ANE. Case Report: previously healthy, five years old male, not vaccinated for seasonal influenza, was admitted with four days of fever and respiratory symptoms. Initial evaluation reveled respiratory impair and he was admitted to the critical care unit for respiratory distress syndrome. Influenza B antigen was detected in upper respiratory swab by immunochromatography. Initial laboratory: White blood count; 20300/L, C- protein reaction: 300mg/L, AST 176 U/L, LDH 2549 U/L. He required 11 days of invasive respiratory support due to severe hypoxemia. When support was withdrawn, severe bilateral visual impairment was observed without other neurological manifestations. Magnetic Resonance Image revels bilateral temporo-occipital cortico-subcortical lesions and in both cerebellar hemispheres, with a lacunar image in the left thalamus; no involvement of the optic nerve was observed. Close watching was workup without pharmacologic intervention. He starts recovering vision 5 month later. Discussion: influenza-associated encephalopathy and acute necrotizing encephalopathy are recognized as rare inflammatory complications associated with influenza and other virus infections. Cases of blindness associated with necrotizing encephalopathy are reported. Treatment with corticosteroids, intravenous immunoglobulin, hypothermia, and plasmapheresis are propose; roll of oseltamivir remain unknown. Tocilizumab represents a potentially rational approach to ANE management. Conclusion: Influenza infection could be severe, including neurological complication. Vaccination is the only primary prevention tool.

Article Details

How to Cite
BADÍA, Federica et al. Blindness Due to Severe Influenza B Infection: Case Report. Medical Research Archives, [S.l.], v. 12, n. 6, june 2024. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/5311>. Date accessed: 22 july 2024. doi: https://doi.org/10.18103/mra.v12i6.5311.
Section
Case Reports

References

1. Fatimah S. Dawood, Joseph Bresee Influenza Viruses Sarah, S. et al. Principles and Practice of Pediatric Infectious Diseases. Available from: Elsevier eBooks+, (5th Edition). Elsevier - OHCE, 2017.
2. Mizuguchi M. Acute necrotizing encephalopathy of childhood: a novel form of acute encephalopathy prevalent in Japan and Taiwan. Brain Dev. 1997 Mar;19(2):81-92. Doi: 10.1016/s0387-7604(96)00063-0. PMID: 9105653
3. Song Y, Li S, Xiao W, et al. Influenza-Associated Encephalopathy and Acute Necrotizing Encephalopathy in Children: A Retrospective Single-Center Study. Med Sci Monit. 2021;27:e928374. Published 2021 Jan 3.
4. Morishima T, Togashi T, Yokota S, Okuno Y, Miyazaki C, Tashiro M, Okabe N; Collaborative Study Group on Influenza-Associated Encephalopathy in Japan. Encephalitis and encephalopathy associated with an influenza epidemic in Japan. Clin Infect Dis. 2002 Sep 1;35(5):512-7. Doi: 10.1086/341407. Epub 2002 Aug 7. PMID: 12173123.
5. Zhang Z, Tan J, Li Y, Zhou X, Niu J, Chen J, Sheng H, Wu X, Yuan Y. Bibliometric analysis of publication trends and topics of influenza-related encephalopathy from 2000 to 2022. Immun Inflamm Dis. 2023 Sep;11(9):e1013. Doi: 10.1002/iid3.1013. PMID: 37773718; PMCID: PMC10510462.
6. Togashi T, Matsuzono Y, Narita M, Morishima T. Influenza-associated acute encephalopathy in Japanese children in 1994-2002. Virus Res. 2004 Jul;103(1-2):75-8. Doi: 10.1016/j.virusres.2004.02.016. PMID: 15163492.
7. Okuno H, Yahata Y, Tanaka-Taya K, Arai S, Satoh H, Morino S, Shimada T, Sunagawa T, Uyeki TM, Oishi K. Characteristics and Outcomes of Influenza-Associated Encephalopathy Cases Among Children and Adults in Japan, 2010-2015. Clin Infect Dis. 2018 Jun 1;66(12):1831-1837. Doi: 10.1093/cid/cix1126. PMID: 29293894; PMCID: PMC5982813.
8. Frankl S, Coffin SE, Harrison JB, Swami SK, McGuire JL. Influenza-Associated Neurologic Complications in Hospitalized Children. J Pediatr. 2021 Dec;239:24-31.e1. Doi: 10.1016/j.jpeds.2021.07.039. Epub 2021 Jul 20. PMID: 34293371; PMCID: PMC9753480.
9. Jantarabenjakul W, Paprad T, Paprad T, Anugulruengkitt S, Pancharoen C, Puthanakit T, Chomtho K. Neurological complications associated with influenza in hospitalized children. Influenza Other Respir Viruses. 2023 Jan;17(1):e13075. Doi: 10.1111/irv.13075. Epub 2022 Dec 13. PMID: 36514185; PMCID: PMC9835412.
10. Shukla P, Mandalla A, Elrick MJ, Venkatesan A. Clinical Manifestations and Pathogenesis of Acute Necrotizing Encephalopathy: The Interface Between Systemic Infection and Neurologic Injury. Front Neurol. 2022 Jan 4;12:628811. Doi: 10.3389/fneur.2021.628811. PMID: 35058867; PMCID: PMC8764155.
11. Denyer S E. Blindness as an immediate sequela of Influenza: recovery Br Med J 1922; 1 :223 Doi:10.1136/bmj.1.3189.223
12. Billa RD, Czech T, Badheka A, et al Influenza B associated acute necrotizing encephalopathy with visual impairment in a child BMJ Case Reports CP 2020;13:e238221.
13. Ichiyama T, Endo S, Kaneko M, Isumi H, Matsubara T, Furukawa S. Serum cytokine concentrations of influenza-associated acute necrotizing encephalopathy. Pediatr Int. 2003 Dec;45(6):734-6. Doi: 10.1111/j.1442-200x.2003.01822.x. PMID: 14651552
14. Okajima K, Hayakawa I, Tsuboi N, Shimura K, Ishiguro A, Abe Y. Early therapeutic plasma exchange may lead to complete neurological recovery in moderate to severe influenza-associated acute necrotizing encephalopathy. Brain Dev. 2022 Aug;44(7):492-497. Doi: 10.1016/j.braindev.2022.03.004. Epub 2022 Mar 23. PMID: 35337691.
15. Koh JC, Murugasu A, Krishnappa J, Thomas T. Favorable Outcomes With Early Interleukin 6 Receptor Blockade in Severe Acute Necrotizing Encephalopathy of Childhood. Pediatr Neurol. 2019 Sep;98:80-84. Doi: 10.1016/j.pediatrneurol.2019.04.009. Epub 2019 Apr 25. PMID: 31201070
16. Huang Y, Zhou B, Hong S and Cai Y (2024) A case report and literature review on tocilizumab-cured acute necrotizing encephalopathy caused by influenza A virus. Front. Pediatr. 12:1351478. Doi: 10.3389/fped.2024.1351478