Purpose or Case Report: Parechovirus infection is a recognized cause of childhood meningoencephalitis with distinctive neuroimaging findings. Human parechovirus (HPeV) is a single-RNA virus from the Picornaviridae viral family transmitted through respiratory or gastrointestinal contact. While the clinical presentation of parechovirus infection usually manifests as mild, self-limiting symptoms, in rare cases, the virus may infect the central nervous system and result in seizures, encephalopathy, and permanent neurologic disability. Pediatric patients younger than two years of age are at greatest risk for central nervous system (CNS) infection. CNS viral infection may be confirmed by lumbar puncture. Typical imaging features of parechovirus encephalitis on brain MR imaging include a diffuse pattern of restricted diffusion involving the subcortical and deep periventricular white matter, predominantly within the frontoparietal region, with additional involvement of the corpus callosum and the bilateral thalami. The differential diagnosis of similar radiologic presentations includes other causes of viral encephalitides (such as rotavirus, chikingunya, and HSV), hypoxic-ischemic encephalopathy, leukodystrophy, and rare genetic metabolic disorders.
A two-week-old male patient without significant past medical history presented to the pediatrician with irritability and increased work of breathing. Within a day, the patient developed worsening tachypnea, increased grunting, pallor, lethargy, and exanthem of the chest and neck. The patient presented to the hospital and was intubated for respiratory distress. Continuous electroencephalography recorded during inpatient admission was notable for abnormal ictal burden consistent with status epilepticus. Brain MR imaging was obtained, and demonstrated the characteristic imaging findings of parechovirus infection of diffuse abnormal restricted diffusion throughout the bilateral subcortical and periventricular white matter, corpus callosum, and thalami, with sparing of the cortex. HPeV RNA was positive in PCR assays of cerebrospinal fluid, serum, and stool. Patient received 2 doses of intravenous immunoglobulin. Unfortunately, there is no current further treatment for parechovirus infection and our patient ended up succumbing to the disease. We hope that this case presentation highlights the unique imaging feature characteristics of parechovirus and can help include this rare infection on the differential for pediatric radiologists moving forward.
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