Adult Febrile Infection-Related Epilepsy Syndrome Mimicking Viral Encephalitis: A Diagnostic Challenge
Bhandari A*, Rawat A, Datta K
ABSTRACT
Background: Febrile Infection-Related Epilepsy Syndrome (FIRES) is an uncommon neurological disorder within the spectrum of new onset refractory status epilepticus (NORSE). It predominantly affects children, while adult presentations are rare and may create diagnostic uncertainty.
Case Presentation: We report a 50-year-old previously healthy man who developed super refractory status epilepticus after a nonspecific febrile illness.Early magnetic resonance imaging demonstrated bilateral mesial temporal abnormalities that were initially interpreted as viral encephalitis, leading to empirical antiviral treatment. Repeated cerebrospinal fluid analyses and extensive infectious and autoimmune investigations remained negative.
Management and Outcome: Seizures persisted despite multiple antiseizure medications and anesthetic therapy. Immunomodulatory treatment with corticosteroids and intravenous immunoglobulin was subsequently initiated, following which seizure activity gradually resolved and neurological recovery occurred.
Conclusion: Adult FIRES may resemble viral encephalitis during the early stage of illness. Repeated diagnostic reassessment and early consideration of immunomodulatory therapy may improve outcomes in NORSE spectrum disorders.
