Successful management of severe paediatric influenza-associated encephalopathy with shock and a reversible splenial lesion using combined immunomodulation and early haemopurification: a case report

Abstract

We describe a rare case of influenza-associated encephalopathy with a reversible splenial lesion. A 2-year and 5-month-old Chinese girl presented with acute fever, two brief seizures, and rapidly deteriorating consciousness (GCS E1V2M2) within 6 hours. Four hours post-admission, high-dose methylprednisolone (30 mg/kg) and intravenous immunoglobulin (2 g/kg) were administered, followed by three consecutive days of continuous blood purification (CBP). Clinical improvement ensued, allowing extubation after 72 hours. MRI on day 4 confirmed MERS with a characteristic isolated splenial lesion. Cytokine levels normalized by day 12 (IL-6: 3.01 pg/mL, IL-10: 2.16 pg/mL), coinciding with complete radiological resolution of the lesion. The child was discharged on day 14. At 1-month follow-up, she exhibited full neurological recovery with age-appropriate function.

Keywords: Encephalitis / encephalopathy with a reversible splenial lesion; influenza; blood purification treatments; immunomodulatory; child.