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Acute Fulminant Cerebral Edema Caused by Coxsackievirus A6 Infection: A Case Report
1Department of Hematology/Oncology Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine Shanghai China.
Insights
Coxsackievirus A6 (CV-A6) is now the leading cause of hand, foot, and mouth disease (HFMD) in China. This report details a fatal pediatric case of severe HFMD caused by CV-A6, resulting in fulminant cerebral edema.
Area of Science:
- Virology
- Neurology
- Pediatrics
Background:
- Coxsackievirus A6 (CV-A6) is emerging as a predominant pathogen in hand, foot, and mouth disease (HFMD) outbreaks in China.
- Previous main causative agents, Enterovirus 71 (EV-71) and Coxsackievirus A16 (CV-A16), are being increasingly replaced by CV-A6.
Purpose of the Study:
- To report a fatal case of severe HFMD caused by CV-A6.
- To highlight the potential for CV-A6 to cause severe neurological complications, specifically fulminant cerebral edema.
Main Methods:
- Case report of a 6-year-old boy with severe HFMD.
- Clinical presentation, neurological examination, brain CT, and nasopharyngeal swab for CV-A6 detection were utilized.
- Diagnosis was confirmed through clinical, laboratory, and imaging findings.
Main Results:
- The patient presented with fever, seizures, unresponsiveness, and signs of severe neurological compromise.
- Brain CT revealed diffuse parenchymal density decrease, indicative of cerebral edema.
- CV-A6 was detected in the nasopharyngeal swab, confirming the causative agent.
- The patient developed fulminant cerebral edema, leading to brain death and subsequent death.
Conclusions:
- CV-A6 infection can lead to severe and fatal neurological complications in children.
- Fulminant cerebral edema is a critical complication associated with severe CV-A6 HFMD.
- Increased vigilance for CV-A6 as a cause of severe HFMD and its neurological sequelae is warranted.
Abstract:
In recent years, Coxsackievirus A6 (CV-A6) has gradually replaced Enterovirus 71 (EV-71) and Coxsackievirus A16 (CV-A16) as the main pathogen causing hand foot mouth disease (HFMD) in China. This article reports a fatal case of HFMD caused by CV-A6, leading to fulminant cerebral edema and cardiopulmonary arrest. A 6-year-old boy was admitted with a chief complaint of "fever for 1 day, two episodes of seizures". On admission, the patient exhibited unresponsiveness, no spontaneous breathing, bilateral fixed and dilated pupils, complete muscle weakness, and loss of muscle tone. The brain computed tomography (CT) revealed diffuse decrease in brain parenchymal density. On the 3rd day of admission, the patient presented with a red rash on the hands, feet, knees, buttocks, and perianal area, and a nasopharyngeal swab was positive for CV-A6. Considering the symptoms, physical examination, laboratory tests, and imaging results, the diagnosis of "severe HFMD, fulminant cerebral edema" is considered. On the 16th day of admission, the patient was diagnosed with brain death, and on the 57th day, the patient died. CV-A6 infection can lead to severe neurological complications, characterized by fulminant cerebral edema, which can result in fatal consequences.
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