A sudden paediatric death due to hand, foot and mouth disease:the importance of vigilance
- Author:
Razuin Rahimi
;
Effat Omar
;
Tuan Suhaila Tuan Soh
;
Siti Farah Alwani Mohd Nawi
;
Shahidan Md Noor
- Publication Type:Case Report
- Keywords:
Hand;
foot and mouth disease;
autopsy;
Enterovirus 71;
sudden death
- From:The Malaysian Journal of Pathology
2017;39(2):167-170
- CountryMalaysia
- Language:English
-
Abstract:
Background: Hand, foot and mouth disease (HFMD) is caused by enteroviruses such as Coxsackie
virus A16 (CVA16) and Enterovirus 71 (EV71). The diagnostic hallmarks are oral ulcers and
maculo-papular or vesicular rash on the hands and feet. Severe form of this disease can lead to
death due to neurological and cardiopulmonary complications. This case report aims to describe a
fatal case of HFMD with minimal oral and skin manifestations. Case report: A four-year-old girl
was brought to a hospital after suddenly becoming unresponsive at home. She had a history of
fever and lethargy for three days prior to her demise. The patient, and five other children in her
neighbourhood had been diagnosed to have HFMD at a local health clinic; the other children had
recovered without complications. Results: Autopsy revealed a few punctate, sub-epidermal vesicles
measuring 1 to 2 mm on the palm of her right hand and sole of the right foot, visible only with a
magnifying glass. Internal examination revealed prominent nodularity at the oro- and hypopharynxes.
The lungs were markedly congested and oedematous. Histopathology of the lung showed marked
oedema and haemorrhage with mild pneumonic changes. Oedema with increase in macroglia
and astrocytic proliferation were seen in the cerebral tissue, but no lymphocytic infiltration was
evident. Enterovirus EV71 was detected by polymerase chain reaction in samples from the lung,
cerebrospinal fluid and serum. The cause of death was given as HFMD complicated by pneumonia.
Conclusion: Fatal HFMD may have minimal signs. A complete history, careful physical examination
and relevant investigations lead to a diagnosis at post mortem examination. Awareness of the subtle
signs and rapid deterioration associated with a fatal case of HFMD is a challenge to clinicians who
encounter these cases.
