11 year boy was presented withfever, vomiting and GTC with GCS of 6 and neurological signswith shock. Hewas given ventilator and circulatory support. MRI was suggestive of Acute disseminated encephalomyelitis [ADEM]. But acute presentation and rapid deterioration, absence of CSF pleocytosis and raised proteins, raised liver enzymes and thalamic involvement on MRIwas suggestive of Acute Necrotizing Encephalopathy [ANE] than ADEM. He was treated with IV antibiotics, Acyclovir, Methyl Prednisolone and Intravenous immunoglobulin. Inspite of all the vigorous measures, our patient died.

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