A reversible lesion of the corpus callosum splenium with adult influenza-associated encephalitis/encephalopathy: a case report

En Kimura , Sadahisa Okamoto , Yuji Uchida , Tomoo Hirahara , Tokunori Ikeda , Teruyuki Hirano and Makoto Uchino

Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Honjo, Kumamoto, 860-0811, Japan

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Journal of Medical Case Reports 2008, 2:220doi:10.1186/1752-1947-2-220


Published:	28 June 2008

Abstract

Introduction

Influenza virus-associated encephalitis/encephalopathy is a severe childhood illness with a poor prognosis. Adult case reports are rare and, to date, there have been no reports of adults with a mild subcortical encephalopathy with reversible lesions of the corpus callosum splenium.

Case presentation

A previously healthy 35-year-old man presented with acute progressive tetraplegia, transcortical motor aphasia and a mild decrease in his consciousness during his recovery after receiving oseltamivir phosphate treatment, and influenza type A antiviral medication. The initial magnetic resonance imaging study at day 1 showed symmetrical diffuse lesions in the white matter and a lesion on the central portion of the corpus callosum splenium. These findings had resolved on follow-up studies at day 8 and day 146. His neurological deficits mostly recovered within 12 hours following methylprednisolone pulse therapy. The levels of interleukin-6 and interleukin-10 in his blood and cerebrospinal fluid were initially elevated, but rapidly decreased to normal levels by day 8.

Conclusion

It is important for clinicians to recognize that even in adulthood, the subcortical encephalopathy observed during the therapeutic treatment for influenza type A infection can occur in conjunction with a reversible lesion of the corpus callosum, which may recover quickly. In addition, the cytokine storm in the blood system and the corticospinal cavity may play an important role in the etiology of the disease process.