title: Massive pulmonary hemorrhage in enterovirus 71-infected hand, foot, and mouth disease.
abstract: Hand, foot, and mouth disease (HFMD) is an acute, mostly self-limiting infection. Patients usually recover without any sequelae. However, a few cases are life threatening, especially those caused by enterovirus 71 (EV71). A 12-month-old boy was admitted to a primary hospital with high fever and vesicular lesions of the mouth, hands, and feet. After 3 days, he experienced 3 seizure episodes and was referred to our hospital. On admission, he was conscious and his chest radiograph was normal. However, 6 hours later, he suddenly lost consciousness and had developed a massive pulmonary hemorrhage that continued until his death. He experienced several more intermittent seizures, and diffuse infiltration of both lung fields was observed on chest radiography. Intravenous immunoglobulin, dexamethasone, cefotaxime, leukocyte-depleted red blood cells, fresh frozen plasma, inotropics, vitamin K, and endotracheal epinephrine were administered. The patient died 9 hours after intubation, within 3 days from fever onset. EV71 subgenotype C4a was isolated retrospectively from serum and nasopharyngeal swab by real-time reverse transcription-polymerase chain reaction. Here, we report a fatal case of EV71-associated HFMD with sudden-onset massive pulmonary hemorrhage and suspected encephalitis.
authors: Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
authors: Dong Seong
authors: DS
authors: Lee
authors: Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
authors: Young Il
authors: YI
authors: Lee
authors: Division of Vaccine Research, Center for Infectious Disease, Korea National Institute of Health, Korea Centers for Disease Control and Prevention, Cheongwon, Korea.
authors: Jeong Bae
authors: JB
authors: Ahn
authors: Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
authors: Mi Jin
authors: MJ
authors: Kim
authors: Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
authors: Jae Hyun
authors: JH
authors: Kim
authors: Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
authors: Nam Hee
authors: NH
authors: Kim
authors: Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
authors: Jong Hee
authors: JH
authors: Hwang
authors: Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
authors: Dong Wook
authors: DW
authors: Kim
authors: Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
authors: Chong Guk
authors: CG
authors: Lee
authors: Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
authors: Tae Won
authors: TW
authors: Song
keywords: Encephalitis; Enterovirus 71; Hand, foot, and mouth disease; Pulmonary hemorrhage