A Fatal Case of HBV-Associated PAN Encephalitis in a Non-Verbal Adult
Location
Suwanee, GA
Start Date
17-4-2026 12:00 PM
End Date
17-4-2026 1:00 PM
Description
In patients with epilepsy, sudden death is often attributed to seizures, sometimes without further investigation for other systemic disease, particularly when the patient is unable to communicate evolving symptoms. Polyarteritis nodosa (PAN), a necrotizing vasculitis involving small- and medium-sized arteries, is an uncommon but potentially fatal cause of multisystem vascular injury and is rarely diagnosed postmortem in young adults.
We report a forensic autopsy case of a 20-year-old non-verbal autistic male with a history of epilepsy who experienced a prolonged seizure at home. Despite extensive resuscitative efforts, the patient sustained severe neurologic injury and died shortly thereafter. Postmortem examination of the brain demonstrated widespread cerebral vasculitis with hemorrhagic infarcts, fibrin thrombi, and disruption of vessel walls. Additional findings included vasculitis involving the pulmonary and cardiac vasculature, as well as chronic active hepatitis with immunohistochemical evidence of hepatitis B virus infection, supporting a diagnosis of hepatitis B–associated PAN.
This case illustrates how systemic inflammatory disease can precipitate or exacerbate seizures and mimic sudden unexpected death in epilepsy. It also highlights the diagnostic vulnerability of non-verbal individuals with neurodevelopmental disabilities, in whom pain and neurologic decline may be expressed atypically and misattributed to baseline conditions. The delayed recognition of both chronic hepatitis B infection and systemic vasculitis underscores broader gaps in preventive screening and diagnostic vigilance in disabled populations. These findings emphasize the critical role of comprehensive forensic investigation in uncovering occult disease and underscore the need for heightened clinical suspicion of systemic pathology when neurologic deterioration occurs in patients with limited ability to communicate symptoms.
Embargo Period
5-15-2026
A Fatal Case of HBV-Associated PAN Encephalitis in a Non-Verbal Adult
Suwanee, GA
In patients with epilepsy, sudden death is often attributed to seizures, sometimes without further investigation for other systemic disease, particularly when the patient is unable to communicate evolving symptoms. Polyarteritis nodosa (PAN), a necrotizing vasculitis involving small- and medium-sized arteries, is an uncommon but potentially fatal cause of multisystem vascular injury and is rarely diagnosed postmortem in young adults.
We report a forensic autopsy case of a 20-year-old non-verbal autistic male with a history of epilepsy who experienced a prolonged seizure at home. Despite extensive resuscitative efforts, the patient sustained severe neurologic injury and died shortly thereafter. Postmortem examination of the brain demonstrated widespread cerebral vasculitis with hemorrhagic infarcts, fibrin thrombi, and disruption of vessel walls. Additional findings included vasculitis involving the pulmonary and cardiac vasculature, as well as chronic active hepatitis with immunohistochemical evidence of hepatitis B virus infection, supporting a diagnosis of hepatitis B–associated PAN.
This case illustrates how systemic inflammatory disease can precipitate or exacerbate seizures and mimic sudden unexpected death in epilepsy. It also highlights the diagnostic vulnerability of non-verbal individuals with neurodevelopmental disabilities, in whom pain and neurologic decline may be expressed atypically and misattributed to baseline conditions. The delayed recognition of both chronic hepatitis B infection and systemic vasculitis underscores broader gaps in preventive screening and diagnostic vigilance in disabled populations. These findings emphasize the critical role of comprehensive forensic investigation in uncovering occult disease and underscore the need for heightened clinical suspicion of systemic pathology when neurologic deterioration occurs in patients with limited ability to communicate symptoms.