2018 Volume 50 Issue 1 Pages 55-59
A 10-day-old boy was hospitalized who presented with fever nine days after birth, and repetitive seizures and central apnea appeared the following day. Diffusion-weighted images of MRI revealed symmetrical characteristic lesions spread throughout the white matter, which suggested human parechovirus type 3 (HPeV-3) encephalitis. Laboratory findings showed abnormality of coagulation, increase of ferritin and neopterin in serum, and neopterin in cerebrospinal fluid without pleocytosis. The patient was treated with intravenous dexamethasone for ten days, because hypercytokinemia was thought to be an important aggravating factor of brain damage. Cystic changes were observed only in the frontal area, but the other white matter lesions diminished. On the twenty-seventh day after onset, he was discharged without neurological deficit. HPeV-3 was detected in the blood, nasal discharge, and cerebrospinal fluid by real-time PCR. Moreover, transverse venous thrombosis was observed at onset, but diminished rapidly by anticoagulation treatment. Immunomodulating treatment using corticosteroids should be considered to prevent the deterioration of brain damage in patients with HPeV-3 encephalitis accompanied by hypercytokinemia.
