Multifocal multilobar focal cortical dysplasia type IIa in Febrile Infection Related Epilepsy Syndrome (FIRES)

A seven-year-old girl with history of type I diabetes and no history of seizures presented for altered mental status with convulsions nearly one week after a febrile illness. Serum and laboratory studies were normal with EEG showing biparietal fast activity and seizures originating from right occipital lobe consistent with FIRES. A collaborative decision was ultimately made to withdraw care. Post-mortem whole brain histopathological examination revealed diffuse abnormalities in multiple areas including both parietal lobes and the right parieto-occipital junction consistent with focal cortical dysplasia type IIa. We believe this to be the first report that describes focal cortical dysplasia type IIa co-localizing with epileptogenic areas on EEG in a case of FIRES, and recommend that focal cortical dysplasia be considered as an etiology early in the course of FIRES.