Acral‐accentuated exanthem in an infant with parechovirus meningitis

Lee, Dong Hoon; Loh, Sin Wee; Tan, Juliet; Chong, Jin Ho

doi:10.1111/pde.13325

Cited by 2 publications

(4 citation statements)

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“…This is only the second case of parechovirus‐associated acral swelling in our centre . The previous patient was a 2‐month‐old girl who presented similarly with fever and irritability and was diagnosed with parechovirus meningitis after extensive tests were done.…”

Section: Discussionmentioning

confidence: 85%

Atypical acral swelling and viral exanthem with parechovirus meningitis

Chowdhury

Lee

2019

J Paediatrics Child Health

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We present a case of a febrile 3-month-old infant with atypical acral swelling and erythema for 2 days' duration. He was born full-term via normal vaginal delivery, with no maternal risk factors for sepsis. His parents sought medical attention in view of increasing lethargy and irritability. On physical examination, there was a blanching maculo-papular rash over the trunk and extremities with acral swelling (Figs 1-3). The infant was febrile (maximum temperature 39.8 C) with tachycardia that was out of proportion to fever spikes. His heart rate was in the range of 180-200 beats/min, which raised concerns for underlying sepsis. Intravenous ampicillin and gentamicin were administered immediately. His white cell count was 5.30 × 10 9 /L (5-15 × 10 9 /L; 48% neutrophils, 41% lymphocytes, 10% monocytes) and C-reactive protein level was unremarkable (6.3 mg/L). Blood, urine and cerebrospinal (CSF) cultures were negative. CSF did not reveal any pleocytosis (CSF WBC 0, CSF protein 0.26 g/L). In view of worsening acral erythema associated with swelling, there were concerns of evolving Kawasaki disease (KD).Blood tests were repeated on the third day of hospitalisation due to concerns of KD as child had persistent irritability and fever Fig. 1 Swelling over dorsum of the foot.Fig. 2 Swelling over dorsum of hand. Key Points1 Acral swelling is an uncommon presentation and should raise concerns for Kawasaki disease or parechovirus infection depending on the clinical context. 2 Parechovirus infection is self-limiting and thus prompt isolation of this virus can prevent unnecessary investigations. 3 Parechovirus infection can present with a range of symptoms from being asymptomatic to sepsis-like illness in an infant.

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Section: Discussionmentioning

confidence: 85%

Atypical acral swelling and viral exanthem with parechovirus meningitis

Chowdhury

Lee

2019

J Paediatrics Child Health

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“…Other frequent symptoms included irritability, from 40 to 100%, poor feeding, from 42 to 81.8%, and tachycardia ranging from 63.6 to 77% [ 12 , 14 , 26 , 41 , 44 – 46 , 51 – 54 , 58 , 60 , 62 – 64 , 67 – 70 ]. In a few cases lethargy was the presenting symptom, with a prevalence between 14% and 51% [ 1 , 12 , 14 , 26 , 60 , 69 ].…”

Section: Discussionmentioning

confidence: 99%

“…Many clinical cases of HPeV CNS infection included a cutaneous sign, as macular or maculo-papular rash, involving mainly truncus and extremities [ 14 , 23 , 41 , 45 , 47 , 54 – 58 , 62 ]. The occurrence of a rash as a presenting sign ranged from 20 to 60% [ 1 , 8 , 11 , 12 , 17 , 21 , 52 , 53 , 60 , 64 , 68 , 69 ].…”

Section: Discussionmentioning

confidence: 99%

“…CRP serum values were normal or slightly elevated. CSF samples had a normal WBC count Clinical Presentation Lee D, 2018 [ 54 ] Case Report Singapore (Asia) 2-month-old girl with fever, irritability, and maculopapular exanthema. On day three, she developed nontender palmoplantar erythema Clinical Presentation Laboratory Masanori T, 2022 [ 55 ] Case Report Japan (Asia) A 2-month-old girl with fever, poor general condition, severe abdominal distention, rash and acral foot reddening showed low values of WBC count and negative CRP.…”

Section: Discussionmentioning

confidence: 99%

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Human parechovirus meningitis in children: state of the art

Bozzola,

Barni,

Barone

et al. 2023

Ital J Pediatr

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Human Parechovirus is a common cause of infection occurring especially during the first years of life. It may present with a broad spectrum of manifestations, ranging from a pauci-symptomatic infection to a sepsis-like or central nervous system disease. Aim of this study is to explore the knowledge on Parechovirus meningitis. According to the purpose of the study, a systematic review of the literature focusing on reports on central nervous system. Parechovirus infection of children was performed following PRISMA criteria. Out of the search, 304 papers were identified and 81 records were included in the revision dealing with epidemiology, clinical manifestations, laboratory findings, imaging, therapy and outcome. Parechovirus meningitis incidence may vary all over the world and outbreaks may occur. Fever is the most common symptom, followed by other non-specific signs and symptoms including irritability, poor feeding, skin rash or seizures. Although several reports describe favourable short-term neurodevelopmental outcomes at discharge after Parechovirus central nervous system infection, a specific follow up and the awareness on the risk of sequelae should be underlined in relation to the reported negative outcome. Evidence seems to suggest a correlation between magnetic imaging resonance alteration and a poor outcome.

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Acral‐accentuated exanthem in an infant with parechovirus meningitis

Abstract: We report a case of an infant who had presented with fever and an acral-accentuated rash, for which his cerebrospinal fluid returned positive for parechovirus. He was treated symptomatically and discharged well, with no long-term complications.

Cited by 2 publications

References 12 publications

Atypical acral swelling and viral exanthem with parechovirus meningitis

Atypical acral swelling and viral exanthem with parechovirus meningitis

Human parechovirus meningitis in children: state of the art

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