Rapidly progressive encephalopathy caused by Coxsackie meningoencephalitis in an elderly male
Masoom Desai1,2, Melissa Motta3
1Department of Neurology, Division of Neurocritical Care and Program in Trauma, University of Maryland Medical Center, Baltimore, MD, USA. masoomdesai@umm.edu.
Insights
Coxsackie virus can cause severe brain inflammation (encephalopathy) even in healthy adults, leading to seizures. Early diagnosis and treatment are crucial for better outcomes in these rare, severe enterovirus infections.
Area of Science:
- Neurology
- Infectious Diseases
- Virology
Background:
- Enteroviruses, including Coxsackie viruses, are frequent causes of aseptic meningitis and encephalitis, typically self-limiting in children.
- Severe presentations are more common in immunocompromised individuals, such as neonates and transplant recipients.
Observation:
- A rare case of rapidly progressive acute encephalopathy due to Coxsackie meningoencephalitis in an immunocompetent adult male is presented.
- The patient experienced refractory status epilepticus, a severe complication of the viral infection.
Findings:
- This case demonstrates that Coxsackie virus infections can lead to severe, rapidly progressive acute encephalopathy and significant morbidity in immunocompetent adults.
- The findings underscore the need to consider enterovirus infections in the differential diagnosis of acute encephalopathy, even in immunocompetent individuals.
Implications:
- The case highlights the importance of a broad differential diagnosis for rapidly progressive acute encephalopathy.
- It emphasizes the need to investigate potential underlying immunodeficiencies in severe viral infections and adopt aggressive diagnostic and therapeutic strategies for better patient outcomes.
Abstract:
Enteroviruses and Coxsackie viruses are common causes of aseptic meningitis and encephalitis in children. These infections usually have a benign, self-limited course. However, they can have a florid presentation in immunocompromised patients, such as neonates, patients exposed to immunosuppressive drugs, such as transplant recipients and patients with agammaglobulinemia. We present a rare case of rapidly progressive acute encephalopathy caused by Coxsackie meningoencephalitis and complicated by refractory status epilepticus in an immunocompetent adult male. Our case highlights the importance of having a broad differential in patients presenting with rapidly progressive acute encephalopathy. Although rare, an enterovirus infection caused by a Coxsackie virus subtype can have a severe presentation causing significant morbidity. This case, also underscores the importance of searching for underlying immunodeficiency in malignant presentations of common viral infections. Hence, rapidly progressive acute encephalopathy due to coxsackievirus can occur in immunocompetent individuals. Aggressive and systematic diagnostic and therapeutic approach in such severe cases can influence overall outcomes.
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