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A case of acute necrotizing encephalopathy (ANE) associated with novel H1N1 influenza A virus infection in a unimmunized 2-year-old girl is reported by investigators from Italy. The child was admitted with a two-day history of recurrent seizures, fever, sore throat, and altered mental status. On physical examination she had nuchal rigidity and severe opisthotonus. The patient’s nasal swab specimen was positive for the novel H1N1 influenza A virus. There was no CSF pleocytosis and PCR testing was negative for influenza A, cytomegalovirus, Epstein-Barr virus, varicella zoster, and enterovirus. An EEG showed generalized medium-high voltage theta-delta waves. MRI showed lesions in the midbrain, brainstem meninges, and cervical cord, and swelling of subcortical white matter of thalami …
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