Enterovirus 71-Induced Fulminant Cardiopulmonary Failure: A Case Report
Pornumpa Bunjoungmanee MD*, Auchara Tangsathapornpong MD*
Affiliation : * Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Background : The spectrum of diseases attributed to enterovirus (EV) 71 includes herpangina and hand-foot-and-mouth
disease (HFMD). EV71 can occasionally cause neurological complications, such as meningitis, encephalitis and poliomyeli-
tis-like paralysis. Neurogenic pulmonary edema (NPE) is a fatal complication in children with EV71 encephalitis.
Case Report : A previously healthy, fully immunized 4-year-old girl presented with fever, cough, rhinorrhea and emesis. She
had no skin or oral mucosal lesions related to HFMD. After admission, she had generalized tonic seizures 3 times and rapidly
developed hypotension with cardiac arrest. Chest radiograph showed pulmonary edema without cardiomegaly. Cardiac
enzymes were elevated. The cerebrospinal fluid (CSF) glucose level was also elevated with no CSF pleocytosis. Histologically,
the brain specimen showed perivascular lymphocytic infiltration with hypoxic ischemic encephalopathy. The real time poly-
merase chain reactions for pan-EV and EV71 from CSF were positive.
Conclusion : Children with EV71 associated NPE have a high case-fatality rate. Early identification and treatment of related
cardiopulmonary disorders is of great importance.
Keywords : Enterovirus 71, Neurogenic pulmonary edema, Encephalitis
