[P2-27] Neonatal encephalitis caused by enterovirus A71 presented with disseminated lesions in cortex and subcortex
[Introduction] Periventricular white matter lesions on magnetic resonance imaging (MRI) is the typical characteristic pattern of neonatal enterovirus encephalitis. We report a case of neonatal enterovirus encephalitis with MRI showing disseminated lesions in cortex and subcortical white matter.[Case description] A 22-day-old baby boy, born full term without complications, was referred to us because of prolonged hypothermia and decreased oral intake. His family had a history of fever 8 days before hospitalization. On admission, he was not doing well even after warming and showed neurological signs of nystagmus, apnea and seizure. Blood test showed mild acidemia, prolongation of APTT, and mild increased of CRP level. Initial cerebrospinal fluid examination result revealed no pleocytosis (white blood cell count 10 /μl) and mild protein elevation (149 mg/dl). MRI showed disseminated lesions mainly in the cortex and subcortical white matter of the both frontal and parietal lobes. Antiepileptic drugs were administered for seizure control. Laboratory results ruled out the involvement of cerebrovascular disorders and metabolic disorders. Comprehensive viral PCR assays detected enterovirus A71 in the blood and fecal specimens, thus a diagnosis of enteroviral encephalitis was made. Cerebrospinal fluid was tested negative for enterovirus. [Conclusions] Typical imaging of enterovirus encephalitis showing involvement of the periventricular white matter was not seen in our case. Enterovirus infection in the neonatal period often shows non-specific symptoms. Absence of pleocytosis, negative detection of viral PCR in cerebrospinal fluid, and atypical MRI findings could present as atypical clinical findings in enterovirus encephalitis.