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I read with great interest the case report by Perez and Montes¹ in a recent issue of the ARCHIVES, which described a 75-year-old patient with encephalitis and peripheral vasculitis associated with Mycoplasma pneumoniae infection. I found that a striking feature of that patient was the magnetic resonance imaging of the brain, which revealed a right pontine hyperintense lesion and multiple bilateral, symmetrical, periventricular hyperintense lesions on T2-weighted images. This characteristic roentgenographic appearance resembles what is called acute necrotizing encephalopathy.^2-3

Acute necrotizing encephalopathy is a newly recognized disease entity that is specifically prevalent among younger children and is characterized by the bilateral, symmetrical, edematous, and necrotic lesions that are confined to the thalamus, pons, and cerebellum. Influenza virus is a leading cause among the infectious agents to which this disease has been ascribed.^2-4 An unfavorable outcome often follows. Interestingly, pathological studies of the brain have revealed that the lesions comprise mainly . . . [Full Text of this Article]

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