2014 Volume 5 Issue 1 Pages 92-95
The patient was a 4-year-old girl brought to our department with chief complaints of fever and clonic convulsions affecting the left side of her body. She had acute encephalopathy with febrile convulsive status epilepticus accompanied by concurrent hypercytokinemia (serum IL-6 36,100pg/mL, cerebrospinal fluid IL-6 2,460pg/mL) and multi-organ failure. We estimated her prognosis was poor. Although we started to treat her with steroids pulse therapy and high-dose gamma globulin, her condition was getting worse with multiple organ failure. However, her life could be saved by a multidisciplinary therapeutic approach including plasma exchange and continuous hemodiafiltration using a cytokine removal filter. As diffusion-weighted magnetic resonance imaging of the head showed high signals in the subcortical white matter of the right cerebral hemisphere, hemiconvulsion-hemiplegia syndrome was diagnosed. Although left hemiparesis remained, she recovered the ability to walk by herself and was discharged about 2.5 months after her admission. Blood purification can remove cytokine effectively and is listed as a special therapy in the influenza-associated encephalopathy treatment guidelines. In acute encephalopathy and encephalitis, cytokine removal by blood purification therapy may contribute to improving both survival and neurological prognosis by rapidly improving hypercytokinemia and inhibiting the progression of tissue damage.
