Journey from H1N1 to Acute Hemorrhagic Leukoencephalitis

A diabetic female in her early fifties experienced a 2-day fever, treated with over-the-counter meds. Later, she became less responsive and was hospitalized. On admission, she exhibited irrelevant speech, drowsiness, and neck stiffness. Computed tomography (CT) and magnetic resonance imaging (MRI) scans were initially normal. Meningoencephalitis was suspected and started on empirical antibiotics and antivirals. Her condition declined, causing a seizure and necessitating intubation and mechanical ventilation. A lumbar puncture showed high glucose and protein, but low cell counts in the cerebrospinal fluid. Contrast MRI revealed features of acute hemorrhagic leukoencephalitis. Swab for H1N1 influenza was positive. Treatment with intravenous methylprednisolone, ceftriaxone, acyclovir, and oseltamivir resulted in significant recovery.