Fulminant neurogenic pulmonary oedema with hand, foot, and mouth disease
Fulminant neurogenic pulmonary oedema with hand, foot, and mouth disease
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DOI：
10.1016/s0140-6736(98)24031-1
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发表时间：
1998-08-01
期刊：
影响因子：
168.9
通讯作者：
Lin, TY
中科院分区：
文献类型：
--
作者：
Chang, LY;Huang, YC;Lin, TY
尸检显示脊髓灰质、顶叶和额叶、中脑、脑桥、延髓和小脑的急性炎症。存在神经吞噬和血管周围混合炎症细胞的缠绕，双肺严重出血和水肿，有轻度透明膜形成，无明显炎症。她的心脏轻度肥厚，无炎症或坏死。肝脏显示出轻微的微泡脂肪变化。从脑中分离出肠道病毒71；髓质；颈、胸、腰脊髓以及直肠和咽喉拭子。没有从血液、肺、肝脏、心脏或胰腺中分离出任何病毒。肠道病毒 71 型可引起多种疾病，包括手足口病；无菌性脑膜炎;脑炎;以及急性弛缓性麻痹。 1-4 然而，此前尚未报道肠道病毒 71 感染后出现急性致命性肺水肿。本例的临床表现和尸检结果表明，肠道病毒71型直接侵犯脊髓和髓质可能是导致肺水肿的原因；其他原因，如压倒性病毒血症、肺炎并随后导致成人呼吸窘迫综合征和心肌炎的可能性较小，因为没有证据表明存在播散性病毒血症、肺炎或心肌炎。
Necropsy showed acute inflammation of the grey matter of the spinal cord, parietal and frontal cerebral lobes, midbrain, pons, medulla, and cerebellum. There was neuronophagia and perivascular cuffing by mixed inflammatory cells, severe haemorrhage and oedema in both lungs, with mild hyaline membrane formation and no notable inflammation. Her heart was mildly hypertrophic without inflammation or necrosis. Liver showed a mild microvescicular fatty change. Enterovirus 71 was isolated from brain; medulla; cervical, thoracic, and lumbar spinal cords as well as from rectal and throat swabs. No virus was isolated from blood, lung, liver, heart, or pancreas.Enterovirus 71 can cause a wide spectrum of diseases, including hand, foot, and mouth disease; aseptic meningitis; encephalitis; and acute flaccid paralysis. 1–4 However, acute fatal pulmonary oedema after enterovirus 71 infection have not been previously reported. Clinical manifestations and necropsy findings in this case show that direct invasion of spinal cord and medulla by enterovirus 71 was probably the cause of pulmonary oedema; other causes such as overwhelming viraemia, pneumonia with subsequent adult respiratory distress syndrome, and myocarditis are less likely because there was no evidence of disseminated viraemia, pneumonia, or myocarditis.