Disseminated cortical and subcortical lesions in neonatal enterovirus 71 encephalitis
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CASE REPORT
Disseminated cortical and subcortical lesions in neonatal enterovirus 71 encephalitis Ryoko Nakamura 1 & Pin Fee Chong 1 & Kohei Haraguchi 1 & Harutaka Katano 2 & Keiko Tanaka-Taya 3 & Ryutaro Kira 1 Received: 11 November 2019 / Revised: 3 April 2020 / Accepted: 13 April 2020 # Journal of NeuroVirology, Inc. 2020
Abstract Enteroviruses are one of the most important causes of viral encephalitis in the neonatal period. However, the non-specificity of the symptoms presented renders its diagnosis challenging. Intracranial MRI has been reported to be a very useful imaging modality that can detect the characteristic white matter lesions around the periventricular regions. In this study, we report a case of a patient with neonatal encephalitis who presented with normal white blood cell counts in the initial cerebrospinal fluid analysis. A lumbar puncture retap identified pleocytosis, and polymerase chain reaction assays detected enterovirus 71 in the blood and stool samples. Furthermore, MRI revealed atypical disseminated cortical and subcortical white matter lesions on diffusion weighted images, and neuroradiological re-evaluation showed necrotic changes 2 weeks later. This unique case expands our knowledge of the spectrum of neurological disorders due to enterovirus 71 infection in neonatal period. Keywords Enterovirus 71 . Neonatal encephalitis . White matter . Disseminated subcortical lesions
Introduction Enteroviruses are important and common causes of aseptic meningitis and viral encephalitis, especially in young children. In general, enteroviruses cause a milder clinical illness than many other etiologies of encephalitis, such as herpes simplex virus (HSV-1 and HSV-2) and Japanese encephalitis virus. An important exception is enterovirus 71 (EV-71), which is a proven neurotropic virus other than poliovirus within the enterovirus genus, capable of producing severe neurological complications (Ooi et al. 2010). EV-71 has been implicated in large outbreaks of hand-footand-mouth disease (HFMD) across the Asia-Pacific region, posing significant public health concerns (Xing et al. 2014). Epidemiological studies revealed an EV-71 prevalence of 15% among healthy Chinese children (median age 4 years) * Pin Fee Chong [email protected] 1
Department of Pediatric Neurology, Fukuoka Children’s Hospital, 5-1-1 Kashiiteriha Higashi-ku, Fukuoka 813-0017, Japan
2
Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
3
Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
(Zhang et al. 2013), and the case prevalence of Enterovirus A is 4.0% among healthy Filipino children < 6 years old (Jiao et al. 2020). A previous large prospective study reported that 10–30% of children admitted due to HFMD developed CNS complications (Ooi et al. 2010). CNS infections with EV-71 are largely restricted to neurons in the dorsal brainstem, cerebellum, and spinal gray matter; neuroimaging usually demonstrates a lack of supratentorial lesions (Teoh et al. 2016). We
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