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A pediatric patient with interstitial pneumonia due to enterovirus D68
Masaaki Matsumoto1, Hiroyuki Awano1, Miki Ogi2
1Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
Insights
Enterovirus D68 (EV-D68) infection can cause severe respiratory issues in children. Early recognition of interstitial pneumonia is crucial for timely treatment and improved outcomes.
Area of Science:
- Pediatric Infectious Diseases
- Respiratory Medicine
- Virology
Background:
- Enterovirus D68 (EV-D68) is a significant pathogen causing respiratory illness in children.
- EV-D68 infections are associated with more severe respiratory complications and higher hospitalization rates compared to other enteroviruses.
- Elucidating the clinical presentation of EV-D68-associated respiratory complications is essential.
Observation:
- A 4-year-old girl with EV-D68 infection experienced rapid respiratory deterioration requiring mechanical ventilation within 24 hours of symptom onset.
- Chest imaging revealed interstitial pneumonia with characteristic patchy, funicular, and frosted glassy shadows.
- Elevated serum markers (surfactant protein-A, surfactant protein-D, KL-6) and bronchoalveolar lavage findings (increased neutrophils and lymphocytes) supported the diagnosis.
Findings:
- The patient was diagnosed with interstitial pneumonia secondary to Enterovirus D68 infection.
- Steroid therapy demonstrated a remarkable positive effect on the patient's condition.
- Rapid respiratory decline in EV-D68 cases warrants consideration of interstitial pneumonia.
Implications:
- This case highlights the potential for EV-D68 to cause severe interstitial pneumonia in pediatric patients.
- Steroids may be an effective treatment for EV-D68-induced interstitial pneumonia, warranting further investigation.
- Prompt diagnosis and management are critical due to the rapid progression of respiratory failure in some EV-D68 infections.
Abstract:
Enterovirus D68 (EV-D68) infection is associated with upper and lower respiratory tract symptoms such as fever, cough, and wheezing. Pediatric patients with EV-D68 infection easily develop more severe respiratory complications compared to patients infected with other species of enterovirus, and consequently, have a higher rate of hospitalization and admission to intensive care units. Therefore, the clinical picture of respiratory complications associated with EV-D68 infection needs to be elucidated. Here, we report a 4-year-old girl of EV-D68 infection that required artificial respiration management within 24 h from the onset of cold symptoms. The patient was diagnosed with interstitial pneumonia on the basis of chest imaging findings with patchy, funicular and frosted glassy shadows, increased blood markers of surfactant protein-A, surfactant protein-D and sialylated carbohydrate antigen KL-6, and increased neutrophils and lymphocytes in the bronchoalveolar lavage. Steroids showed a remarkable effect in her treatment. Further investigations are needed to confirm the efficacy of steroids for interstitial pneumonia due to EV-D68 infection. As rapid deterioration of respiratory status is observed in EV-D68 infection, the possibility of interstitial pneumonia may be considered.
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