Elsevier

Legal Medicine

Volume 6, Issue 4, October 2004, Pages 252-255
Legal Medicine

Case report
An adult autopsy case of acute encephalopathy associated with influenza A virus

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Abstract

On a cold winter morning, a 35-year-old male was unexpectedly found dead and therefore autopsied. Macro- and microscopically, the lungs were demonstrated bronchopneumonia. On the surface of brain, small blood vessels were slightly congested. Microscopically, brain edema was also observed, and proliferation of lymphocytes was observed around the capillary vessels of the hippocampus. These findings suggested a viral infection of the cerebrum. We conducted an immunohistochemical study with antibody against influenza virus. Influenza A virus antigen was detected in both the lungs and brain. Therefore, findings were compatible with influenza A encephalopathy. Even when serological inspection is not performed, it is useful to inspect localization of the virus antigen immunohistochemically. We considered that it is necessary to perform pathological examination for influenza encephalopathy in sudden death cases when influenza is epidemic.

Introduction

Influenza viruses cause respiratory tract infections. Recently, encephalopathy has received attention as a complication in infants [1], [2], [3]. In this study, we performed an autopsy on a 35-year-old male. Bronchopneumonia was observed macroscopically, but the existence of encephalopathy was not diagnosed until subsequent histopathological examination. In this report, we investigated pathological findings to diagnosis influenza encephalopathy as the cause of death in this case.

Section snippets

Case report

On a cold winter day, a 35-years-old male was arrested by the police for cheating and stealing food, ‘Sushi’. He told the policeman that he had not eaten a satisfactory meal for several days. He also complained of general fatigue and a slight fever. However, he did not receive medical treatment. Early the next morning, he was found dead in the police cell. Saliva-like fluid around the mouth and incontinence were observed, but there were no other abnormalities on macroscopic inspection. The body

Discussion

The macroscopic appearance of acute viral encephalitis as follows: meningeal opacity or vascular congestion, generalized or localized swelling of the brain, softening of neural tissue [5]. However, these findings are not specific, and would also be affected by the state immediately before death. Microscopically, cell infiltration around the vessels, glial nodules, neuronophagia, perivascular cuffing, and inclusion bodies are characteristic findings in viral infection [6]. These findings present

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