脳低体温療法，抗サイトカイン療法，抗ウイルス療法が有効であったインフルエンザ脳症症例

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  • A case of influenza virus-associated encephalopathy successfully treated with a combination of mild hypothermia, anticytokine and antivirus agents

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A 4-year-old boy diagnosed with influenza virus-associated encephalopathy was admitted to our ICU. On admission, the level of consciousness was II-20 according to Japan coma scale. Body temperature was 40.4°C and brain CT showed cerebral edema. Combination therapy of mild hypothermia, anticytokine and antivirus agents was initiated immediately after admission based on the recent published findings that inflammatory cytokines play a major role in the pathogenesis of influenza virus-associated encephalopathy. During the course of treatment, a brain CT revealed an attenuation of brain edema. Hypothermia was discontinued on hospital day 5. The patient recovered consciousness and was extubated on hospital day 8. Single photon emission computed tomography (SPECT) revealed increased cerebral blood flow and positron emission tomography (PET) of the brain revealed improved glucose metabolism of bilateral basal ganglia and thalami on hospital day 10 in comparison with the findings on admission. The patient was discharged without any neurological sequelae on hospital day 17. This treatment strategy appears to be effective for managing severe influenza encephalopathy.

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