Table 1_Febrile infection-related epilepsy syndrome with claustrum sign following a human rhinovirus-positive respiratory illness in an adult: a case report.docx

Severe neurological complications, including febrile infection-related epilepsy syndrome (FIRES), are exceptionally rare.</p>Case presentation<p>We report a case of febrile infection-related epilepsy syndrome (FIRES) with bilateral claustral involvement occurring in temporal association with an HRV-positive febrile respiratory illness, identified at the General Hospital of Ningxia Medical University in April 2025.

The patient presented with acute refractory status epilepticus following a prodromal febrile illness. Neuroimaging revealed bilateral claustral hyperintensities and symmetrical thalamic lesions, while continuous electroencephalographic monitoring demonstrated burst-suppression patterns with frontotemporal discharges. HRV was detected in a respiratory tract specimen by nucleic acid testing but was not detected in the cerebrospinal fluid; the relationship between HRV detection and the neurological syndrome is therefore interpreted as a temporal association rather than a proven causal one, since a single respiratory detection may represent asymptomatic carriage rather than active infection.</p>Conclusions<p>This case underscores the importance of considering FIRES in patients with acute encephalopathy following a respiratory infection, even when the implicated pathogen—human rhinovirus in this case—is detected only in the respiratory tract, where it may represent either active infection or asymptomatic carriage.