{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T14:12:58Z","timestamp":1764943978518,"version":"3.46.0"},"reference-count":10,"publisher":"SMC Media","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Introduction:\u00a0Acute necrotizing encephalopathy (ANE) is a rare but severe neurological condition, typically triggered by viral infections, including influenza. It is characterized by a dysregulated immune-inflammatory host response, leading to rapid neurological deterioration, including encephalopathy and multifocal brain lesions. Diagnosis and treatment are challenging, and the condition is associated with high morbidity and mortality. Case description:\u00a0We report the case of a 48-year-old immunocompetent male who presented twice to the emergency department with fever and rapidly progressing altered consciousness, followed by generalized seizures. Neuroimaging revealed characteristic bilateral thalamic lesions and diffuse cerebral haemorrhage. Rapid diagnostic testing confirmed influenza A virus infection, leading to the diagnosis of influenza-associated acute necrotizing encephalopathy. Despite the initiation of antiviral therapy with oseltamivir, along with high-dose intravenous corticosteroids and immunoglobulins, the patient passed away due to severe neurological complications. Discussion:\u00a0Adult-onset ANE is exceptionally rare, particularly in Western populations, and is associated with a fulminant clinical course. Common features include altered mental status and seizures, often progressing to severe outcomes despite treatment. Given its non-specific prodromal symptoms and rapid neurological decline, early recognition and prompt neuroimaging are essential for diagnosis and management. Increased awareness of this condition among clinicians may facilitate earlier intervention and potentially improve outcomes. Conclusion:\u00a0The present case report highlights the fatal outcome of ANE as a rare complication of Influenza A infection in an immunocompetent adult.<\/jats:p>","DOI":"10.12890\/2025_005932","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T15:50:41Z","timestamp":1762357841000},"source":"Crossref","is-referenced-by-count":0,"title":["Influenza A-associated acute necrotizing encephalopathy in an immunocompetent adult"],"prefix":"10.12890","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4952-230X","authenticated-orcid":false,"given":"Maria","family":"Loukaki","sequence":"first","affiliation":[{"name":"Second Department of Internal Medicine, Venizeleio Pananeio General Hospital, Heraklion, Crete, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5065-7121","authenticated-orcid":false,"given":"Loukia","family":"Vassilopoulou","sequence":"first","affiliation":[{"name":"Second Department of Internal Medicine, Venizeleio Pananeio General Hospital, Heraklion, Crete, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theocharis","family":"Gregoriou","sequence":"first","affiliation":[{"name":"Second Department of Internal Medicine, Venizeleio Pananeio General Hospital, Heraklion, Crete, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georgia","family":"Tsoumi","sequence":"first","affiliation":[{"name":"Second Department of Internal Medicine, Venizeleio Pananeio General Hospital, Heraklion, Crete, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmanouil","family":"Giannakoudakis","sequence":"first","affiliation":[{"name":"General Department of Neurology, Venizeleio Pananeio General Hospital, Heraklion, Crete, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evangelos","family":"Volakakis","sequence":"first","affiliation":[{"name":"Department of Intensive Care Medicine, Venizeleio Pananeio General Hospital, Heraklion, Crete, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charalampos","family":"Lydakis","sequence":"first","affiliation":[{"name":"Second Department of Internal Medicine, Venizeleio Pananeio General Hospital, Heraklion, Crete, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10397","published-online":{"date-parts":[[2025,11,5]]},"reference":[{"key":"10.12890\/2025_005932_ref1","unstructured":"Yen WL, Lee KH, Huang HJ, Tsai MJ. Influenza A-Associated Acute Necrotizing Encephalopathy. J Acute Med 2020;10:96-97. doi: 10.6705\/j.jacme.202003_10(2).0007"},{"key":"10.12890\/2025_005932_ref2","doi-asserted-by":"crossref","unstructured":"Mizuguchi M, Abe J, Mikkaichi K, Noma S, Yoshida K, Yamanaka T, et al. Acute necrotising encephalopathy of childhood: a new syndrome presenting with multifocal, symmetric brain lesions. J Neurol Neurosurg Psychiatry 1995;58:555-561. doi: 10.1136\/jnnp.58.5.555","DOI":"10.1136\/jnnp.58.5.555"},{"key":"10.12890\/2025_005932_ref3","doi-asserted-by":"crossref","unstructured":"Keshari Das B, Gautam S, Meher N, Thavanati PKR, Singh S. Influenza associated acute necrotizing encephalopathy and COVID-19 encephalopathy; a comparative review. J Ren Endocrinol 2022;8:e25062. doi: 10.34172\/jre.2022.25062","DOI":"10.34172\/jre.2022.25062"},{"key":"10.12890\/2025_005932_ref4","doi-asserted-by":"crossref","unstructured":"Erdil E, Vural E, Koytak PK, Tuncer EN. Successful treatment of influenza B associated acute necrotizing encephalopathy in an adult using combination of high dose oseltamivir\u2013IVIG\u2013pulse metylprednisolone. Acta Neurol Belg 2021;121:1863-1865. doi: 10.1007\/s13760-020-01462-8","DOI":"10.1007\/s13760-020-01462-8"},{"key":"10.12890\/2025_005932_ref5","doi-asserted-by":"crossref","unstructured":"Voudris KA, Skaardoutsou A, Haronitis I, Vagiakou EA, Zeis PM. Brain MRI findings in influenza A-associated acute necrotizing encephalopathy of childhood. Eur J Paediatr Neurol 2001;5:199-202. doi: 10.1053\/ejpn.2000.0511","DOI":"10.1053\/ejpn.2000.0511"},{"key":"10.12890\/2025_005932_ref6","doi-asserted-by":"crossref","unstructured":"Hernandez R, Ota R, Medina Y, Hernandez Y, Julayanont P, Wilms H. Acute necrotizing encephalopathy. Proc (Bayl Univ Med Cent) 2022;35:725-727. doi: 10.1080\/08998280.2022.2086781","DOI":"10.1080\/08998280.2022.2086781"},{"key":"10.12890\/2025_005932_ref7","doi-asserted-by":"crossref","unstructured":"Akins PT, Belko J, Uyeki TM, Axelrod Y, Lee KK, Silverthorn J. H1N1 encephalitis with malignant edema and review of neurologic complications from influenza. Neurocrit Care 2010;13:396-406. doi: 10.1007\/s12028-010-9436-0","DOI":"10.1007\/s12028-010-9436-0"},{"key":"10.12890\/2025_005932_ref8","doi-asserted-by":"crossref","unstructured":"Erdil E, Vural E, Koytak PK, Tuncer EN. Successful treatment of infuenza B associated acute necrotizing encephalopathy in an adult using combination of high dose oseltamivir\u2013IVIG\u2013pulse methylprednisolone. Neurocrit Care 2010;13:396-406. doi: 10.1007\/s12028-010-9436-0","DOI":"10.1007\/s12028-010-9436-0"},{"key":"10.12890\/2025_005932_ref9","doi-asserted-by":"crossref","unstructured":"Frutos AM, Cleary S, Reeves EL, Ahmad HM, Price AM, Self WH, et al. Interim Estimates of 2024-2025 Seasonal Influenza Vaccine Effectiveness - Four Vaccine Effectiveness Networks, United States, October 2024-February 2025. MMWR Morb Mortal Wkly Rep 2025;74:83-90. doi: 10.15585\/mmwr.mm7406a2","DOI":"10.15585\/mmwr.mm7406a2"},{"key":"10.12890\/2025_005932_ref10","doi-asserted-by":"crossref","unstructured":"Grijalva CG, Nguyen HQ, Zhu Y, Mellis AM, McGonigle T, Meece JK, et al. Estimated Effectiveness of Influenza Vaccines in Preventing Secondary Infections in Households. JAMA Netw Open 2024;7:e2446814. doi: 10.1001\/jamanetworkopen.2024.46814. 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