Influenza-associated encephalopathy mimicking dermatoneuro syndrome

Dermatoneuro syndrome (DNS) is a rare diagnosis of exclusion characterised by fever, altered mental status and seizures in patients with scleromyxoedema. We present a complex case of a patient presenting with a fever, coma, seizures, rigidity and deep T2 fluid-attenuated inversion recovery hyperintensities in the context of both scleromyxoedema and influenza A with extensive, negative infectious workup. This case highlights the shared clinical features of DNS and influenza-associated encephalopathy, the latter being the eventual diagnosis for our patient. We review the DNS literature focusing on presentation, adequacy of investigation, treatment and prognosis. Finally, we provide an initial workup for patients with suspected DNS, including nasopharyngeal influenza PCR.