Adenovirus encephalitis associated with acute hepatitis: case report

Case presentation: Male, 6 years old, admitted to the hospital due to altered mental status (Glasgow Coma Scale = 3) preceded by fever, vomiting, fatigue, hypothermia and seizures. The patient presented with refractory hypoglycemia and jaundice at physical examination. Blood tests showed altered hepatic function (AST 548UI/L, ALT 2833UI/L, total bilirubin 5,81mg/dL, INR 5,2, albumin 2,4 g/dL), and serologies for viral hepatitis were negative. Acyclovir was started due to the possibility of viral encephalitis. Evaluation included electroencephalogram with signs of accentuated diffuse encephalopathy, with moderate irritative activity in the left temporal lobe; brain magnetic resonance imaging showed hyperintensity in T2/FLAIR in the periventricular and deep white matter; viral culture in the cerebrospinal fluid was positive for adenovirus. It was opted to discontinue acyclovir. He presented with improvement of lethargy and hepatic function after 5 days but evolved with irritability and ataxia. Brain magnetic resonance imaging was repeated, showing discretely larger white matter lesions, spreading to the semioval centers and corona radiata. Supportive care was continued and the patient showed normal gait and behavior after 5 days, being released with no complementary treatment. Electroencephalogram before hospital discharge showed focal paroxysms in the left parieto-occipital region, but the patient did not have new seizures.

Discussion: The adenovirus family is an important cause of infection in children, with over 60 serotypes, causing more commonly respiratory and gastrointestinal infections, usually self-limited. Rarely, they can cause other types of infection, such as encephalitis, and in such cases can either cause mild or potentially fatal disease. Seizures are associated with worse prognosis. In the case above, the patient presented with associated acute hepatitis, compatible with the outbreak of adenovirus hepatitis of April of 2022. Thus, this is an unusual case characterized by systemic disease due to a common virus in childhood. There is no electroencephalogram specific or imaging findings. Treatment consists of supportive care.

Final comments: Adenovirus encephalitis is a rare disease in childhood, but can cause severe neurologic complications. It must be investigated in patients with evidence of central nervous system infection, especially susceptible groups, such as immunosuppressed individuals.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
18 September 2023