Korean J Pediatr.  2016 Jul;59(7):308-311. 10.3345/kjp.2016.59.7.308.

Distinctive clinical features of HPeV-3 infection in 2 neonates with a sepsis-like illness

• Yeom JS
• Park JS
• Seo JH
• Park ES
• Lim JY
• Park CH
• Woo HO
• Youn HS
• Lee OJ
• Han TH
• Chung JY

• KMID: 2350053
• DOI: http://doi.org/10.3345/kjp.2016.59.7.308

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.

Keyword

Parechovirus; Newborn; Exanthema; Ferritins

MeSH Terms

Aspartate Aminotransferases
Cerebrospinal Fluid
Erythema
Exanthema
Ferritins
Fever
Humans
Immunoglobulins
Infant, Newborn*
L-Lactate Dehydrogenase
Parechovirus
Virology
Aspartate Aminotransferases
Ferritins
Immunoglobulins
L-Lactate Dehydrogenase