Author: Jonathan Gibson, Srividya Sreekantam, Antonio Ochoa-Ferraro, Neena Johal / Editor: Stephen Sheridan / Codes: / Published: 17/07/2026
An 8-year-old boy presents with vomiting, abnormal movements and acute behavioral change. He is markedly agitated and combative, with fluctuating drowsiness and episodes of confusion, which are out of keeping with his baseline. Physical restraint is required to facilitate initial investigations. There is no history of preceding intercurrent illness.
He has mild learning difficulties and is undergoing assessment for autism, attending mainstream school. Over the preceding year, he has experienced three episodes of viral illness associated with vomiting, confusion and prolonged recovery. His family describe him as a fussy eater with avoidance of protein-rich foods. He takes no regular medications and has no known drug allergies.
In the Emergency Department (ED), he is screened for presumed sepsis and commenced on intravenous antibiotics, antivirals and fluids. Diazepam is administered for agitation. Inflammatory markers are within normal limits. Owing to persistent altered conscious level, further biochemical investigations are undertaken to determine the cause of his acute encephalopathy.
Overnight, his Glasgow Coma Score (GCS) deteriorates from 14 to 6, with repeat blood tests demonstrating worsening metabolic disturbance. In view of reduced conscious level and abnormal biochemistry, he requires urgent transfer to paediatric intensive care for intubation, ventilation and specialist management.
Despite biochemical correction following intensive care therapy, he sustains significant neurological injury, requiring prolonged rehabilitation.
