Journal of Clinical Virology 61 (2014) 463–465
Contents lists available at ScienceDirect
Journal of Clinical Virology journal homepage: www.elsevier.com/locate/jcv
Case Report
Optic neuritis associated with influenza B virus meningoencephalitis F.A. Vianello b,∗∗ , S. Osnaghi a , E.A. Laicini b , G.P. Milani b,∗ , G. Tardini b , A.M. Cappellari c , G. Lunghi d , C.V. Agostoni e , E.F. Fossali b Foundation IRCCS, Ca Granda Ospedale Maggiore Policlinico, Oculistic Department, Milan, Italy Foundation IRCCS, Ca Granda Ospedale Maggiore Policlinico, Pediatric Emergency Department, Milan, Italy c Foundation IRCCS, Ca Granda Ospedale Maggiore Policlinico, Department of Neuroscience and Mental Health, Milan, Italy d Foundation IRCCS, Ca Granda Ospedale Maggiore Policlinico, Laboratory Department, Virology Unit, Milan, Italy e Department of Clinical Sciences and Community Health, University of Milan, IRCCS Ospedale Maggiore Policlinico, Pediatric Clinic 2, Milan, Italy a
b
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Article history: Received 12 August 2014 Received in revised form 17 September 2014 Accepted 19 September 2014
a b s t r a c t Various postinfectious neurological manifestations have been described associated to influenza viruses. Optic neuritis is a serious, often reversible disease reported among several infectious diseases and vaccines complications. We report a case of optic neuritis following an influenza B virus infection in a 10-year-old male. © 2014 Elsevier B.V. All rights reserved.
Keywords: Influenza B virus Optic neuritis Neurological complications
1. Introduction Most of the influenza virus infection symptoms are respiratory or gastrointestinal, associated with a good prognosis. However, several neurological complications, ranging from mild manifestations to acute necrotising encephalopathy have been reported [1–3]. Optic neuritis (ON) consists of the optic nerve inflammation, resulting in sudden painful vision loss or impaired function of the affected eye [4]. It has been associated with influenza vaccination both in children and adults [5]. Anecdotally, ON was reported after an influenza A virus infection, too [6]. We describe the case of a child with ON following an influenza B virus meningoencephalitis. 2. Why this case is important Optic neuritis is an inflammatory, demyelinating disease causing acute visual loss. A prompt treatment in children is associated with a good prognosis in most cases [4,7]. Diagnosis of ON can
Abbreviations: ON, optic neuritis; CSF, cerebrospinal fluid; OCT, Optical Coherence Tomography; MS, multiple sclerosis. ∗ Corresponding author at: Via della Commenda 9, 20122 Milan, Italy. Tel.: +39 3498320575. ∗∗ Corresponding author at: Via della Commenda 9, 20122 Milan, Italy, Tel.: +39 3407071964. E-mail addresses: [email protected] (F.A. Vianello), [email protected] (G.P. Milani). http://dx.doi.org/10.1016/j.jcv.2014.09.010 1386-6532/© 2014 Elsevier B.V. All rights reserved.
be difficult and delay the treatment. Clinicians should be aware of the possibility of ON among complications of influenza viruses infections. 2.1. Case description A 10-year-old boy was admitted to our paediatric emergency department for asthenia, drowsiness, leg tremors and muscular pain for 24 h and fever, cough and rhinitis for 4 days. On admission vital signs were as follows: axillary temperature 38.4 ◦ C, heart rate 120 beats/min, blood pressure 115/75 mmHg, respiratory rate 30 breaths/min, and oxygen saturation 98% while breathing ambient air. On physical examination, the child was agitated, with deteriorating consciousness and confusion. Three episodes of rhythmic legs movements lasting 2–3 min occurred during clinical examination. Brudzinski and Kernig signs were positive. No petechiae were present. A complete blood cell count revealed (reference ranges in brackets): 17.870 WBC/mm3 [4.800–12.100 mm−3 ] (80% neutrophils, 9% lymphocytes and 11% monocytes), haemoglobin level was 12 g/dl [10.5–14.5 g/dl], haematocrit 34.1% [34.5–42.5%], and platelet count was 551.000 mm−3 [150.00–450.00 mm−3 ]. Inflammatory indices and coagulation panel values were normal. Serum glucose level was 87 mg/dl. Cerebrospinal fluid (CSF) analysis revealed: WBC count of 70 cells/mm3 [
Contents lists available at ScienceDirect
Journal of Clinical Virology journal homepage: www.elsevier.com/locate/jcv
Case Report
Optic neuritis associated with influenza B virus meningoencephalitis F.A. Vianello b,∗∗ , S. Osnaghi a , E.A. Laicini b , G.P. Milani b,∗ , G. Tardini b , A.M. Cappellari c , G. Lunghi d , C.V. Agostoni e , E.F. Fossali b Foundation IRCCS, Ca Granda Ospedale Maggiore Policlinico, Oculistic Department, Milan, Italy Foundation IRCCS, Ca Granda Ospedale Maggiore Policlinico, Pediatric Emergency Department, Milan, Italy c Foundation IRCCS, Ca Granda Ospedale Maggiore Policlinico, Department of Neuroscience and Mental Health, Milan, Italy d Foundation IRCCS, Ca Granda Ospedale Maggiore Policlinico, Laboratory Department, Virology Unit, Milan, Italy e Department of Clinical Sciences and Community Health, University of Milan, IRCCS Ospedale Maggiore Policlinico, Pediatric Clinic 2, Milan, Italy a
b
a r t i c l e
i n f o
Article history: Received 12 August 2014 Received in revised form 17 September 2014 Accepted 19 September 2014
a b s t r a c t Various postinfectious neurological manifestations have been described associated to influenza viruses. Optic neuritis is a serious, often reversible disease reported among several infectious diseases and vaccines complications. We report a case of optic neuritis following an influenza B virus infection in a 10-year-old male. © 2014 Elsevier B.V. All rights reserved.
Keywords: Influenza B virus Optic neuritis Neurological complications
1. Introduction Most of the influenza virus infection symptoms are respiratory or gastrointestinal, associated with a good prognosis. However, several neurological complications, ranging from mild manifestations to acute necrotising encephalopathy have been reported [1–3]. Optic neuritis (ON) consists of the optic nerve inflammation, resulting in sudden painful vision loss or impaired function of the affected eye [4]. It has been associated with influenza vaccination both in children and adults [5]. Anecdotally, ON was reported after an influenza A virus infection, too [6]. We describe the case of a child with ON following an influenza B virus meningoencephalitis. 2. Why this case is important Optic neuritis is an inflammatory, demyelinating disease causing acute visual loss. A prompt treatment in children is associated with a good prognosis in most cases [4,7]. Diagnosis of ON can
Abbreviations: ON, optic neuritis; CSF, cerebrospinal fluid; OCT, Optical Coherence Tomography; MS, multiple sclerosis. ∗ Corresponding author at: Via della Commenda 9, 20122 Milan, Italy. Tel.: +39 3498320575. ∗∗ Corresponding author at: Via della Commenda 9, 20122 Milan, Italy, Tel.: +39 3407071964. E-mail addresses: [email protected] (F.A. Vianello), [email protected] (G.P. Milani). http://dx.doi.org/10.1016/j.jcv.2014.09.010 1386-6532/© 2014 Elsevier B.V. All rights reserved.
be difficult and delay the treatment. Clinicians should be aware of the possibility of ON among complications of influenza viruses infections. 2.1. Case description A 10-year-old boy was admitted to our paediatric emergency department for asthenia, drowsiness, leg tremors and muscular pain for 24 h and fever, cough and rhinitis for 4 days. On admission vital signs were as follows: axillary temperature 38.4 ◦ C, heart rate 120 beats/min, blood pressure 115/75 mmHg, respiratory rate 30 breaths/min, and oxygen saturation 98% while breathing ambient air. On physical examination, the child was agitated, with deteriorating consciousness and confusion. Three episodes of rhythmic legs movements lasting 2–3 min occurred during clinical examination. Brudzinski and Kernig signs were positive. No petechiae were present. A complete blood cell count revealed (reference ranges in brackets): 17.870 WBC/mm3 [4.800–12.100 mm−3 ] (80% neutrophils, 9% lymphocytes and 11% monocytes), haemoglobin level was 12 g/dl [10.5–14.5 g/dl], haematocrit 34.1% [34.5–42.5%], and platelet count was 551.000 mm−3 [150.00–450.00 mm−3 ]. Inflammatory indices and coagulation panel values were normal. Serum glucose level was 87 mg/dl. Cerebrospinal fluid (CSF) analysis revealed: WBC count of 70 cells/mm3 [
