Case Report: A severe case of human parechovirus encephalitis in a neonate

Human parechovirus is a common pathogen causing respiratory and gastroenterological symptoms. Symptoms range from asymptomatic courses to rare encephalitis or sepsis-like symptoms. Studies regarding neurodevelopment after parechovirus encephalitis in infants are conflicting with indications of possible short or long term neurodevelopmental impairments. In this case report we describe an especially severe course of human parechovirus infection.

A two-week-old infant presented with fever and developed seizures and apneic episodes after admission. Laboratory tests revealed leukopenia. A lumbar puncture revealed parechovirus via polymerase chain reaction (PCR). Recurrent seizures required extensive anticonvulsive therapy. Invasive ventilation for four days was necessary due to apneic episodes. Cranial magnetic resonance imaging (MRI) revealed white matter involvement.

In neonates with a sepsis-like presentation and largely unremarkable laboratory and cerebrospinal fluid findings, parechovirus encephalitis is an important differential diagnosis. In this case, follow-up examinations showed age-appropriate neurodevelopment. However, owing to the severe clinical presentation and extensive neuroimaging abnormalities, long-term neurodevelopmental monitoring is warranted.