Acute necrotising encephalopathy (ANE) due to influenza: an unrecognised encephalopathy in childhood

Acute necrotising encephalopathy (ANE) of childhood is a rare, rapidly progressive and often fatal form of encephalopathy characterised by distinctive clinical and neuroradiological features. It typically presents with a sudden and progressive alteration of consciousness, along with the characteristic finding of multifocal, symmetric lesions involving the thalami, brainstem, cerebellum and cerebral white matter. Although its exact pathogenesis remains unclear, it is thought to result from a cytokine storm triggered by viral infections, leading to blood-brain barrier disruption and brain injury. There is currently limited evidence on optimal treatment and no established consensus to standardise management. This case series presents three paediatric cases of influenza A-associated ANE, all of whom initially exhibited mild neurological symptoms but rapidly deteriorated to coma and death. These cases highlight the urgent need for further research and the development of standardised treatment guidelines for this severe and under-recognised condition.