Background: The spectrum of diseases attributed to enterovirus (EV) 71 includes herpangina and hand-foot-and-mouth disease (HFMD). EV71 can occasionally cause neurological complications, such as meningitis, encephalitis and poliomyelitis-like paralysis. Neurogenic pulmonary edema (NPE) is a fatal complication in children with EV71 encephalitis.
Case Report: A previously healthy, fully immunized 4-year-old girl presented with fever, cough, rhinorrhea and emesis. She had no skin or oral mucosal lesions related to HFMD. After admission, she had generalized tonic seizures 3 times and rapidly developed hypotension with cardiac arrest. Chest radiograph showed pulmonary edema without cardiomegaly. Cardiac enzymes were elevated. The cerebrospinal fluid (CSF) glucose level was also elevated with no CSF pleocytosis. Histologically, the brain specimen showed perivascular lymphocytic infiltration with hypoxic ischemic encephalopathy. The real time polymerase chain reactions for pan-EV and EV71 from CSF were positive.
Conclusion: Children with EV71 associated NPE have a high case-fatality rate. Early identification and treatment of related cardiopulmonary disorders is of great importance.

Keywords: Enterovirus 71, Neurogenic pulmonary edema, Encephalitis