Anakinra in Severe RSV-Associated Autoinflammatory Encephalopathy With Delayed ADEM-Like Changes.
Oi-Wa Chan, Yi-Ting Cheng, Yi-Hsuan Liu et al.
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Case in brief
Two previously healthy children developed rapidly progressive encephalopathy following RSV infection. Initial brain MRI scans were normal, but subsequent imaging revealed multifocal white matter lesions resembling acute disseminated encephalomyelitis. Both patients were unresponsive to high-dose corticosteroids and intravenous immunoglobulin, but treatment with anakinra led to neurologic and radiologic recovery.
Diagnostic / clinical pearl
Clinicians should consider repeat neuroimaging in cases of RSV-associated encephalopathy, as initial scans may not reveal significant findings.
Why it matters
This case underscores the potential role of IL-1 in RSV-related neuroinflammation and the need for targeted immunomodulatory therapies in refractory cases.