Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Massive pulmonary hemorrhage in enterovirus 71-infected hand, foot, and mouth disease

  • Lee, Dong Seong (Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Lee, Young Il (Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Ahn, Jeong Bae (Division of Vaccine Research, Center for Infectious Disease, Korea National Institute of Health, Korea Centers for Disease Control and Prevention) ;
  • Kim, Mi Jin (Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Kim, Jae Hyun (Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Kim, Nam Hee (Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Hwang, Jong Hee (Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Kim, Dong Wook (Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Lee, Chong Guk (Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Song, Tae Won (Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine)
  • Received : 2013.08.22
  • Accepted : 2014.01.20
  • Published : 2015.03.10
Download PDF
⟨ Previous Next ⟩

Abstract

Hand, foot, and mouth disease (HFMD) is an acute, mostly self-limiting infection. Patients usually recover without any sequelae. However, a few cases are life threatening, especially those caused by enterovirus 71 (EV71). A 12-month-old boy was admitted to a primary hospital with high fever and vesicular lesions of the mouth, hands, and feet. After 3 days, he experienced 3 seizure episodes and was referred to our hospital. On admission, he was conscious and his chest radiograph was normal. However, 6 hours later, he suddenly lost consciousness and had developed a massive pulmonary hemorrhage that continued until his death. He experienced several more intermittent seizures, and diffuse infiltration of both lung fields was observed on chest radiography. Intravenous immunoglobulin, dexamethasone, cefotaxime, leukocyte-depleted red blood cells, fresh frozen plasma, inotropics, vitamin K, and endotracheal epinephrine were administered. The patient died 9 hours after intubation, within 3 days from fever onset. EV71 subgenotype C4a was isolated retrospectively from serum and nasopharyngeal swab by real-time reverse transcription-polymerase chain reaction. Here, we report a fatal case of EV71-associated HFMD with sudden-onset massive pulmonary hemorrhage and suspected encephalitis.

Keywords

References

  1. Kim SJ, Kim JH, Kang JH, Kim DS, Kim KH, Kim KH, et al. Risk factors for neurologic complications of hand, foot and mouth disease in the Republic of Korea, 2009. J Korean Med Sci 2013; 28:120-7.
  2. Chen KT, Chang HL, Wang ST, Cheng YT, Yang JY. Epidemiologic features of hand-foot-mouth disease and herpangina caused by enterovirus 71 in Taiwan, 1998-2005. Pediatrics 2007;120:e244-52. https://doi.org/10.1542/peds.2006-3331
  3. Zhang YC, Jiang SW, Gu WZ, Hu AR, Lu CT, Liang XY, et al. Clinicopathologic features and molecular analysis of enterovirus 71 infection: report of an autopsy case from the epidemic of hand, foot and mouth disease in China. Pathol Int 2012;62:565-70. https://doi.org/10.1111/j.1440-1827.2012.02837.x
  4. Choi CS, Choi YJ, Choi UY, Han JW, Jeong DC, Kim HH, et al. Clinical manifestations of CNS infections caused by enterovirus type 71. Korean J Pediatr 2011;54:11-6. https://doi.org/10.3345/kjp.2011.54.1.11
  5. Ryu WS, Kang B, Hong J, Hwang S, Kim J, Cheon DS. Clinical and etiological characteristics of enterovirus 71-related diseases during a recent 2-year period in Korea. J Clin Microbiol 2010;48:2490-4. https://doi.org/10.1128/JCM.02369-09
  6. Kim KH. Enterovirus 71 infection: an experience in Korea, 2009. Korean J Pediatr 2010;53:616-22. https://doi.org/10.3345/kjp.2010.53.5.616
  7. Liu JT, Peng D, Guan XH, Zou DD, Zhao DC. Clinical characteristics and treatment assessments of severe enterovirus 71 infected children. Zhonghua Er Ke Za Zhi 2010;48:24-8.
  8. He SJ, Chen D, Zheng XQ, Wang CX, Huang AR, Jin YM, et al. Three cases of enterovirus 71 infection with pulmonary edema or pulmonary hemorrhage as the early clinical manifestation. Zhonghua Er Ke Za Zhi 2008;46:513-6.
  9. Lum LC, Wong KT, Lam SK, Chua KB, Goh AY. Neurogenic pulmonary oedema and enterovirus 71 encephalomyelitis. Lancet 1998;352:1391.
  10. Chang LY, Lin TY, Hsu KH, Huang YC, Lin KL, Hsueh C, et al. Clinical features and risk factors of pulmonary oedema after enterovirus-71-related hand, foot, and mouth disease. Lancet 1999;354:1682-6. https://doi.org/10.1016/S0140-6736(99)04434-7
  11. Ooi MH, Wong SC, Lewthwaite P, Cardosa MJ, Solomon T. Clinical features, diagnosis, and management of enterovirus 71. Lancet Neurol 2010;9:1097-105. https://doi.org/10.1016/S1474-4422(10)70209-X
  12. Tseng FC, Huang HC, Chi CY, Lin TL, Liu CC, Jian JW, et al. Epidemiological survey of enterovirus infections occurring in Taiwan between 2000 and 2005: analysis of sentinel physician surveillance data. J Med Virol 2007;79:1850-60. https://doi.org/10.1002/jmv.21006
  13. Kung SH, Wang SF, Huang CW, Hsu CC, Liu HF, Yang JY. Genetic and antigenic analyses of enterovirus 71 isolates in Taiwan during 1998-2005. Clin Microbiol Infect 2007;13:782-7. https://doi.org/10.1111/j.1469-0691.2007.01745.x
  14. Ortner B, Huang CW, Schmid D, Mutz I, Wewalka G, Allerberger F, et al. Epidemiology of enterovirus types causing neurological disease in Austria 1999-2007: detection of clusters of echovirus 30 and enterovirus 71 and analysis of prevalent genotypes. J Med Virol 2009;81:317-24. https://doi.org/10.1002/jmv.21374
  15. Ma E, Lam T, Chan KC, Wong C, Chuang SK. Changing epidemiology of hand, foot, and mouth disease in Hong Kong, 2001-2009. Jpn J Infect Dis 2010;63:422-6.

Cited by

  1. Etiology of Multiple Non-EV71 and Non-CVA16 Enteroviruses Associated with Hand, Foot and Mouth Disease in Jinan, China, 2009—June 2013 vol.10, pp.11, 2015, https://doi.org/10.1371/journal.pone.0142733
  2. Hand, foot and mouth disease (HFMD): emerging epidemiology and the need for a vaccine strategy vol.205, pp.5, 2015, https://doi.org/10.1007/s00430-016-0465-y
  3. Diffuse alveolar hemorrhage and recombinant factor VIIa treatment in pediatric patients vol.59, pp.3, 2015, https://doi.org/10.3345/kjp.2016.59.3.105
  4. Cytokine and Chemokine Profiling in Patients with Hand, Foot and Mouth Disease in Singapore and Malaysia vol.8, pp.None, 2015, https://doi.org/10.1038/s41598-018-22379-6
  5. Association of polymorphisms in the vitamin D receptor gene with severity of hand, foot, and mouth disease caused by enterovirus 71 vol.91, pp.4, 2019, https://doi.org/10.1002/jmv.25349
  6. MRI reveals segmental distribution of enterovirus lesions in the central nervous system: a probable clinical evidence of retrograde axonal transport of EV-A71 vol.25, pp.3, 2015, https://doi.org/10.1007/s13365-019-00724-3
  7. Hand, foot, and mouth disease in Changsha City, China, 2009-2017: a new method to analyse the epidemiological characteristics of the disease vol.52, pp.1, 2015, https://doi.org/10.1080/23744235.2019.1675902
  8. Association of polymorphisms in the vitamin D receptor gene with susceptibility to and severity of hand, foot, and mouth disease caused by coxsackievirus A16 vol.92, pp.3, 2020, https://doi.org/10.1002/jmv.25603
  9. Virucidal activity and the antiviral mechanism of acidic polysaccharides against Enterovirus 71 infection in vitro vol.64, pp.3, 2020, https://doi.org/10.1111/1348-0421.12763
  10. Characterization of oral virome and microbiome revealed distinctive microbiome disruptions in paediatric patients with hand, foot and mouth disease vol.7, pp.1, 2015, https://doi.org/10.1038/s41522-021-00190-y