Hyperthermia may be connection to hemorrhagic shock, encephalopathy syndrome

Lung DC. Pediatr Infect Dis J. 2011;doi:10.1097/INF.0b013e3182273c64.

A case of a 3-year-old boy developing hemorrhagic shock and encephalopathy syndrome from pandemic 2009 H1N1 influenza revealed that hyperthermia could be related to the development of the syndrome, according to researchers.

“In the present case, the patient had high fever up to a maximum of 41.7·C, which accounts for the hyperthermia triggering the [hemorrhagic shock and encephalopathy syndrome],” the researchers wrote.

Associated with influenza-associated encephalitis/encephalopathy, patients experiencing hemorrhagic shock and encephalopathy syndrome (HSE) have symptoms such as disseminated intravascular coagulation, shock, diarrhea, severe metabolic acidosis, and liver and renal failure.

The 3-year-old was brought to the hospital after having persistent cough and fever for 3 days and the development of diarrhea 1 day before admission. He developed atonic seizures, two episodes of bradycardia with hypotension, and was pale and unresponsive. After undergoing laboratory tests revealing evidence of thrombocytopenia and deranged liver function, and the administration of several vaccines to help stabilize him, he was found to have pandemic 2009 H1N1 influenza.

“Although the exact pathogenesis of HSE remains unknown, it has been postulated to be related to hyperthermia and hypercytokinemia,” the researchers wrote. “Although HSE has been postulated to be related to hyperthermia, there is not concrete evidence to prove this theory. Genetic predisposition and inborn errors of metabolism have been suspected to predispose an individual to thermal stress, and hence the development of HSE.”

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