DrAkshay ,DrJayasree,Aswin Prabhu,DrPerraju Brendapudi ,DrC Jayakumar
AIMS KOCHI
Eight day old Term /AGA/Male vaginal delivery with a birth weight if 3kg presented with complaints of low grade fever and abnormal movements in the form of deviation or mouth to right side with right hand clonic movements.
There is history refusal of feeds
History is negative for birth asphyxia
and sepsis
No history of seizures for the family members
Differential diagnosis considered were
1.Meningitis
2.Dyselectrolytemia /Hypoglyecmia
3 Structural malformations
4.Idiopathic epilepsy
5Drug withdrawal
6IEM
On examination
Child was irritable.
Febrile – 99.3F ,
GRBS-90mg/dl ,
Electolytes-normal.
Sepsis screen – negative.
CSF study Normal
MRI Brain was done which showed multiple linear and scattered FLAIR hyper intensity showing diffusion restriction in bilateral peri ventricular white matter, centrum semiovale and corpus callosum which was suggestive of infection associated leukoencephalopathy.
Viral PCR from CSF was positive for Human Parecho virus. EEG was dysmature with multifocal epileptiform abnormalities in sleep. He was discharged on three months course of oral phenobarbitone.
Now ba is 4 months and is off AEDs. Doing well and has attained all milestones for age.
There is no focal neurological deficit.
Discussion :
Human parechovirus is one differential diagnosis of neonatal meningoencephalitis or sepsis.
Transmission is fecal oral route. Characteristically presents with fever , irritability and diffuse rash.
They can also present with septic shock. MRI characteristic features include bilateral supratentorial white matter abnormalities with corresponding restricted diffusion.
Most human parechovirus infections occur in infants. The spectrum of clinical manifestations includes neonatal sepsis, meningitis, encephalitis, and paralysis .In a retrospective review of 58 pediatric cases in which human parechovirus was isolated from the CSF, the mean age was 6.6 weeks and the most common symptoms were irritability, fever, and nonspecific rash
Differential diagnosis includes hypoxic ischemic encephalopathy ,
Molybdenum factor deficiency
Isolated sulphite oxide deficiency.
Child has to be on antiepileptic drugs and can be tapered off after repeating EEG and there is no further events.
Take home message : Parechovirus meningoencephiltis should be an important differential diagnosis in a newborn presenting with seizure / sepsis.