Acute Fulminant Cerebral Edema Caused by Coxsackievirus A6 Infection: A Case Report

In recent years, Coxsackievirus A6 (CV-A6) has gradually replaced Enterovirus 71 (EV-71) and Coxsackievirus A16 (CV-A16) as the main pathogen causing hand foot mouth disease (HFMD) in China. This article reports a fatal case of HFMD caused by CV-A6, leading to fulminant cerebral edema and cardiopulmonary arrest. A 6-year-old boy was admitted with a chief complaint of "fever for 1 day, two episodes of seizures". On admission, the patient exhibited unresponsiveness, no spontaneous breathing, bilateral fixed and dilated pupils, complete muscle weakness, and loss of muscle tone. The brain computed tomography (CT) revealed diffuse decrease in brain parenchymal density. On the 3rd day of admission, the patient presented with a red rash on the hands, feet, knees, buttocks, and perianal area, and a nasopharyngeal swab was positive for CV-A6. Considering the symptoms, physical examination, laboratory tests, and imaging results, the diagnosis of "severe HFMD, fulminant cerebral edema" is considered. On the 16th day of admission, the patient was diagnosed with brain death, and on the 57th day, the patient died. CV-A6 infection can lead to severe neurological complications, characterized by fulminant cerebral edema, which can result in fatal consequences.