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Computed tomography (CT) and magnetic resonance imaging (MRI) scans were initially normal. Meningoencephalitis was suspected and started on empirical antibiotics and antivirals. Her condition declined, causing a seizure and necessitating intubation and mechanical ventilation. A lumbar puncture showed high glucose and protein, but low cell counts in the cerebrospinal fluid. Contrast MRI revealed features of acute hemorrhagic leukoencephalitis. Swab for H1N1 influenza was positive. 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