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Ann Child Neurol > Volume 22(3); 2014 > Article
Journal of the Korean Child Neurology Society 2014;22(3):173-177.
DOI: https://doi.org/10.26815/jkcns.2014.22.3.173    Published online September 30, 2014.
Enterovirus 71 Brainstem Encephalitis Presenting with Pulmonary Hemorrhage and Acute Heart Failure.
Myoung Sook Lee, Eun Hee Kim, Yun Jeong Lee, Ki Won Oh, Kyung Yeon Lee
1Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea. pdsnoopy@naver.com
2Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
Abstract
Enterovirus 71 has been recognized as being highly central nervous system (CNS) involved and presents with diverse neurologic manifestations. Brainstem encephalitis is the most common neurologic manifestation of CNS involvement by enterovirus 71, and manifests myoclonus, ataxia, tremor, and autonomic dysfunction such as pulmonary hemorrhage. Here we report a 31-month-old girl with enterovirus 71 brainstem encephalitis presenting with pulmonary hemorrhage and acute heart failure. The patient was admitted to emergency department of our hospital due to high-grade fever, vomiting, myoclonus, and tremor 4 days after hand, foot and mouth disease. Four hours after admission, the patient presented with pulmonary hemorrhage and acute heart failure. CSF analysis demonstrated white blood cell 60/mm3, red blood cell 1/mm3, protein 43.0 mg/dL, and glucose 149 mg/dL. Despite aggressive management including intravenous immunoglobulin, milrinone and empirical antimicrobial therapy, the patient died due to uncontrolled pulmonary hemorrhage and shock in 15 hours after admission at emergency department. In stool specimen obtained from the patient, enterovirus 71 (subgenotype C4a) was detected. This case suggests that an early diagnosis of central nervous system involvement in patient with enterovirus 71 infection is vital because brainstem encephalitis resulting from enterovirus 71 infection can rapidly progress to the critical state of disease.
Key Words: Enterovirus 71, Encephalitis, Pulmonary hemorrhage, Heart failure, Hand, foot and mouth disease


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