This case highlights that severe EV71 infection with central nervous system involvement and neurogenic pulmonary oedema can occur in teenagers, even in the absence of typical hand, foot, and mouth lesions.
Alerts clinicians to atypical EV71 in teens with neurogenic oedema sans rash; hypothesis-generating and warrants prospective surveillance.
Enterovirus type 71 ( EV71) infections are mainly found in infants. The severe cases are characterised by nervous system damage, acute circulatory and respiratory failures. So far, there has been no report of EV71 infection involving central nervous system in teenagers or young adults. We first reported a case of 15-year-old Han Chinese male who was infected by EV71, developed neurogenic pulmonary oedema rapidly, and had the risk factors including hyperglycaemia, significant leukocytosis and acute flaccid paralysis. The nucleic acids for EV71 were positive by Reverse transcriptase polymerase chain reaction (RT-PCR). The patient didn't belong to high risk population. Maculopapular rashes and blisters were also not found in hand, foot and mouth. These might be responsible for the failure to make an early diagnosis. (Hong Kong j.emerg.med. 2014;21:176-180)
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Chen et al. (2014) studied this question.
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