Oseltamivir
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Influenza virus-associated encephalitis/ encephalopathy: case report A 35-year-old man developed influenza virus-associated encephalitis/encephalopathy after being treated with oseltamivir for an influenza A virus infection. Within 24 hours of the onset of a high fever, the man was administered three oseltamivir 75mg capsules. The following day, he presented with an acute, progressive tetraplegia and transcortical motor aphasia. His mental status was mildly altered. An MRI revealed lesions throughout the white matter and reduced diffusion, particularly on the central part of the corpus callosum splenium. Cerebrospinal pressure was high (235mm H20) but his cerebrospinal fluid was otherwise normal. He displayed mild thrombocytopenia (12 × 104cells/mL) and leucopenia (2500 cells/mL). The levels of cytokines in his blood serum (IL-6 and IL-10) were elevated; in his cerebrospinal fluid the lL-6 level was high (19.6 pg/mL). Methylprednisolone pulse therapy was administered for 3 days, and the man’s condition quickly improved. Blood serum and cerebrospinal fluid cytokine levels had normalised by day 8, and the MRI findings had also resolved. Following a 2-week rehabilitation, he completely recovered. After 24 days in hospital, he was discharged home. On day 146, no further findings were noted on a follow-up MRI. Author comment: "[O]seltamivir phosphate could have aggravated his condition; this selective neuraminidase inhibitor might influence the development of a pathological mechanism that results in vasogenic edema followed by a cytokine storm. It may play a role in aggregating influenza virus particles on the surface of blood cells, endothelial cells or arachnoid cells. These aggregates might then stimulate the release of pro-inflammatory cytokines from these cells." Kimura E, et al. A reversible lesion of the corpus callosum splenium with adult influenza-associated encephalitis/encephalopathy: a case report. Journal of Medical Case Reports 2: [9 pages], No. 220, 28 Jun 2008. Available from: URL: http:// 801052645 www.jmedicalcasereports.com - Unknown
0114-9954/10/1210-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 12 Jul 2008 No. 1210
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