Hand-foot-mouth disease combined with neurogenic pulmonary edema in children: 11 cases report

Abstract

Objective To analyze clinical presentations of children's neurogenic pulmonary edema due to severe hand-foot-mouth disease (HFMD), and inquire the effective treatment.  Methods The clinical data of 11 children diagnosed as neurogenic pulmonary edema associated with severe HFMD in our hospital were retrospectively analyzed. The clinical manifestation, laboratory examination, imaging and neuropsychological examination were analyzed.  Results All patients were younger than 5 years, and all contacted with severe HFMD. They presented with fever, skin rash, irritability and pulmonary edema. Glasgow Coma Scale (GCS) score of 4 cases was ≤ 7 on admission; head MRI of 5 cases showed long T₁ and T₂ signals in pons and medulla, 2 cases showed long T₂ signal in pons, and one case showed long T₁ and T₂ signals in medulla; echocardiography ejection fraction (EF) of 9 cases was ≥ 41.50%. Patients were treated by tracheal intubation assisted ventilation, decreasing intracranial pressure, rational vasoactive agents, corticosteroids, intravenous immunoglobulin (IVIg) assisted by nerve cells nutrition and myocardial support. Antibiotic therapy was used when combined with breathing machine related pneumonia. After treatment, 3 cases (3/11) died, 3 cases (3/11) were cured and 5 cases (5/11) had paralysis sequelae and referred to rehabilitation. Conclusions Neurogenic pulmonary edema combined with severe HFMD has acute onset, rapid proceeding and high mortality. Tracheal intubation assisted ventilation, decreasing intracranial pressure, rational vasoactive agents, corticosteroids and IVIg can improve the prognosis. The key points of treatment are early tracheal intubation assisted ventilation and proper treating of neurogenic circulation dysfunction.

DOI: 10.3969/j.issn.1672-6731.2018.03.009