Why the confusion in Hashimoto's encephalopathy?

A 13-year-old girl presented with an afebrile seizure followed by prolonged confusion and visual hallucinations. Initial investigations in the form of blood tests, cerebrospinal fluid analysis and head imaging by CT, were normal. She represented with two further episodes within a period of 3 weeks. Further investigations considering infective, metabolic and some autoimmune causes of encephalopathy were negative. An MRI head scan was normal. Thyroid function testing disclosed primary hypothyroidism and elevated antithyroid antibodies. She responded well to glucocorticoid therapy for presumed Hashimoto's encephalopathy (HE). HE describes patients with various neurological manifestations with elevated titres of antithyroid antibodies. There are no clear criteria for diagnosis, with many cases labelled as HE. Responses to corticosteroid therapy are favourable. In patients with unexplained encephalopathy, HE should be considered given the favourable response to glucocorticoid therapy.

First reported cluster of overwhelming group A streptococcal septicaemia and associated chickenpox infection in the UK.

We report the first reported cases of epidemiologically linked invasive group A streptococcal septicaemia, with one fatality, following primary chickenpox infection in previously fit and well children who attended the same preschool. Invasive group A streptococcal sepsis is a well documented complication of chickenpox, which requires prompt and aggressive treatment. Following the cluster, public health measures were put in place to prevent further disease. Varicella vaccination has been shown to significantly reduce hospital admissions as well as deaths related to chickenpox infection. This is the first reported cluster of two epidemiologically linked patients in the UK.