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Case report
Cardiopulmonary failure as a result of brainstem encephalitis caused by enterovirus D68
  1. Naoki Yogo,
  2. Tomohiko Imamura,
  3. Yuichiro Muto and
  4. Katsuki Hirai
  1. Department of Paediatrics, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
  1. Correspondence to Dr Naoki Yogo; naoki.y0715{at}


Enterovirus D68 (EV-D68) causes respiratory illnesses such as pneumonia, and has been reported to cause acute flaccid myelitis. Enterovirus A71 (EV-A71) is known to cause cardiopulmonary failure due to brainstem encephalitis, but there have been few reports of these conditions being associated with EV-D68. Outbreaks of EV-D68 infection have occurred in the USA, Canada, Europe and Asia. Clinical management is largely supportive and there are no specific antivirals available. The case patient, a 4-year-old girl, had cardiopulmonary failure due to brainstem encephalitis. EV-D68 was isolated from a throat swab. On admission, she had cardiopulmonary failure, which required intensive care using a ventilator and inotropic agents. Her cardiac function improved, but she had residual bulbar paralysis and limb weakness, which resolved over a 6-month period. This case confirms that EV-D68, may cause severe illness due to brainstem encephalitis, similar to that caused by EV-A71.

  • heart failure
  • infectious diseases
  • paediatric intensive care
  • neurology

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  • Contributors NY, TI and YM conceptualised and designed the study. NY, TI and YM collected and analysed data. NY wrote the majority of the original draft of the paper. KH provided technical support and conceptual advice. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.