Pediatr Infect Vaccine.  2019 Dec;26(3):199-205. 10.14776/piv.2019.26.e16.

Early Detection and Successful Treatment of Vertically Transmitted Fulminant Enteroviral Infection Associated with Various Forms of Arrhythmia and Severe Hepatitis with Coagulopathy

• Lee SR
• Ko SY
• Yoon SY
• Lee YK
• Shin SM

• KMID: 2466465
• DOI: http://doi.org/10.14776/piv.2019.26.e16

Abstract

Enteroviral infections are common in neonates. One important infection pathway is vertical transmission from an infected mother to her neonate. Here, we report the early detection and successful treatment of a vertically transmitted fulminant enteroviral infection associated with myocarditis and hepatitis. The patient had a sudden onset of high fever on the fourth day of life and developed severe, rapidly progressing symptoms of disseminated intravascular coagulopathy (DIC), hepatitis, and myocarditis accompanied by tachyarrhythmia. As it was the peak season for enteroviral infections and both the mother and the patient's 36-month-old sibling had a high fever around the time of delivery, we suspected an enteroviral infection. Thus, we initiated prompt evaluation of enteroviral infection, as well as close observation and intensive care of the neonate. We strongly recommend evaluation for the possibility of vertical enterovirus infection in neonates when the mother is suspected of having a viral infection (e.g., high fever and negative results from bacterial infectious studies) around the time of delivery and when the neonate shows some early symptoms of infectious diseases such as thrombocytopenia, DIC, hepatitis, and myocarditis. Early detection of enteroviral infections and prompt implementation of proper treatment are key to reduce the risk of complications and mortality associated with enteroviral infections in neonates.

Keyword

Enterovirus; Myocarditis; Arrhythmias, cardiac; Hepatitis; Infant, newborn

MeSH Terms

Arrhythmias, Cardiac*
Child, Preschool
Communicable Diseases
Critical Care
Dacarbazine
Enterovirus
Enterovirus Infections
Fever
Hepatitis*
Humans
Infant, Newborn
Mortality
Mothers
Myocarditis
Seasons
Siblings
Tachycardia
Thrombocytopenia
Dacarbazine

Figure

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  Fig. 1 Initial chest radiograph of the newborn demonstrates prominent pulmonary vascular markings.

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  Fig. 2 The electrocardiogram on the 7th day of life showing a high-degree of heart rate irregularity of more than 200 beats/min. Abbreviations: aVR, augmented vector right; aVL, augmented vector left; aVF, augmented vector foot.

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  Fig. 3 (A) The ECG during the recovery phase from enterovirus myocarditis. Various ECG changes are shown, including supraventricular tachycardia, junctional ectopic tachycardia, and T-wave inversion. (B) The ECG shows complete recovery of normal heart rhythm. Abbreviations: ECG, electrocardiogram; aVR, augmented vector right; aVL, augmented vector left; aVF, augmented vector foot.

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  Fig. 4 The course of laboratory findings and treatments. Abbreviations: WBC, white blood cell; Hb, hemoglobin; PT, prothrombin time; aPTT, activated partial thromboplastin time; CRP, C-reactive protein; AST, aspartate aminotransferase; ALT, alanine aminotransferase; PCR, polymerase chain reaction.

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