Encephalitis related to a H1N1 vaccination: Case report and review of the literature

• Influenza A/H1N1 2009 infection caused serious morbidity and mortality.
• Brain or spinal cord demyelination may occur after vaccination or infection.
• We report a case of encephalitis soon after vaccination for influenza A/H1N1.
• 22 cases of central nervous demyelination linked to influenza A/H1N1 were reported.
• As well A/H1N1 infection as vaccination against this virus may cause encephalitis.

ObjectivesTo illustrate that acute, even dramatic, demyelination of the central nervous system and encephalitis can occur after viral i.e. influenza A/H1N1 vaccination or infection.Patients and methodsWe describe a case of encephalitis/acute disseminated encephalomyelitis associated with vaccination against influenza A/H1N1 and review the available literature.ResultsWe report a case of a 26-year-old female who developed symptoms of acute encephalitis 5 days after vaccination against the pandemic 2009 A/H1N1 influenza. MRI of the brain showed confluent T2-hyperintense signal intensity changes in the deep white matter which further confirmed the diagnosis of encephalitis/acute disseminated encephalomyelitis. Despite therapy with immunoglobulins and corticosteroids, her persistent vegetative state continued. In light of the dramatic cause of this case, we reviewed all 21 other previously reported cases of central nervous system demyelination related to H1N1 vaccination and/or infection.ConclusionsThe available data suggest that even severe central nervous system demyelination i.e. acute encephalitis/disseminated encephalomyelitis and transverse myelitis may very rarely be associated with vaccination against novel influenza A/H1N1 or with A/H1N1 infection itself.