Acute necrotizing encephalitis outbreak in India: A little-known disease among the adult population

A 65-year-old man presented in emergency department with fever, altered sensorium, and a history of controlled diabetes and tobacco chewing. Upon examination, the patient was unconscious with a Glasgow coma scale score of eight. CSF demonstrated IgM antibodies to Japanese encephalitis virus. Neuroimaging revealed extensive T2/FLAIR hyperintensities in the basal ganglia, thalamus and substantia nigra. Gradient echo sequences (GRE) revealed hemorrhagic changes consistent with acute Necrotizing Encephalopathy (ANE). The patient was managed in the intensive care unit and started regaining his sensorium over the next two weeks. At discharge, he was fully conscious but needed support for walking.