title: Distinctive clinical features of HPeV-3 infection in 2 neonates with a sepsis-like illness.
abstract: We report a human parechovirus-3 (HPeV-3) infection in 2 neonates who had prolonged fever (>5 days) with palmar-plantar erythema. This distinctive rash was observed 4-5 days after fever onset, just before defervescence. Elevated aspartate aminotransferase, lactate dehydrogenase, and ferritin levels were characteristic laboratory findings in the 2 cases, suggesting tissue damage caused by hypercytokinemia. Case 1 was treated with intravenous immunoglobulin, considering the possibility of severe systemic inflammatory responses. The initial ferritin level was 385 ng/mL (range, 0-400 ng/mL); however, the level increased to 2,581 ng/dL on day 5 after fever onset. Case 2 presented with milder clinical symptoms, and the patient recovered spontaneously. HPeV-3 was detected in cerebrospinal fluid and/or blood samples, but no other causative agents were detected. The findings from our cases, in accordance with recent studies, suggest that clinical features such as palmar-plantar erythema and/or hyperferritinemia might be indicators of HPeV-3 infection in neonates with sepsis-like illness. In clinical practice, where virology testing is not easily accessible, clinical features such as palmar-plantar erythema and/or hyperferritinemia might be helpful to diagnose HPeV-3 infection.
authors: Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.; Gyeongsang Institute of Health Science, Jinju, Korea.
authors: Jung Sook
authors: JS
authors: Yeom
authors: Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.; Gyeongsang Institute of Health Science, Jinju, Korea.
authors: Ji Sook
authors: JS
authors: Park
authors: Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.; Gyeongsang Institute of Health Science, Jinju, Korea.
authors: Ji-Hyun
authors: JH
authors: Seo
authors: Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.; Gyeongsang Institute of Health Science, Jinju, Korea.
authors: Eun Sil
authors: ES
authors: Park
authors: Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.; Gyeongsang Institute of Health Science, Jinju, Korea.
authors: Jae-Young
authors: JY
authors: Lim
authors: Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.; Gyeongsang Institute of Health Science, Jinju, Korea.
authors: Chan-Hoo
authors: CH
authors: Park
authors: Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.; Gyeongsang Institute of Health Science, Jinju, Korea.
authors: Hyang-Ok
authors: HO
authors: Woo
authors: Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.; Gyeongsang Institute of Health Science, Jinju, Korea.
authors: Hee-Shang
authors: HS
authors: Youn
authors: Department of Pediatrics, Sejong General Hospital, Bucheon, Korea.
authors: Ok Jeong
authors: OJ
authors: Lee
authors: Department of Laboratory Medicine, Inje University Sanggyepaik Hospital, Inje University College of Medicine, Seoul, Korea.
authors: Tae-Hee
authors: TH
authors: Han
authors: Department of Pediatrics, Inje University Sanggyepaik Hospital, Inje University College of Medicine, Seoul, Korea.
authors: Ju-Young
authors: JY
authors: Chung
keywords: Exanthema; Ferritins; Newborn; Parechovirus