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Abstract: Five-year-old Wen was brought to the doctor by her parents because of fever, herpes, headache, and convulsions. I confirmed Wen’s diagnosis of hand, foot, and mouth disease combined with viral encephalitis through elaboration by Wen’s father and a detailed physical examination. After communicating with Wen’s father, she was given ribavirin injection, mannitol injection, short term hydrocortisone as appropriate, full doses of intravenous human immunoglobulin and TCM treatment.
Basic information】Female, 5 years old
Type of disease】Viral encephalitis, hand-foot-mouth disease
Hospital】The First Affiliated Hospital of Zhengzhou University
Date of Consultation】March, 2020
Treatment plan】Medication (ribavirin injection, mannitol injection, hydrocortisone injection, intravenous human immunoglobulin (pH4), raw vein san)
【Treatment cycle】 Hospitalization for 1 week, follow-up after 2 weeks
Treatment effect】Thermal temperature returned to normal, herpes disappeared, no abnormalities in physical examination and auxiliary examination
I. Initial consultation
When I first saw Wenwen, she was being held by her father and was in a poor state of mind, with red herpes visible on her hands. Her father told me that there was a case of HFMD in Wenwen’s kindergarten, and that she had a sudden fever in the morning with a temperature of 38.1°C, red herpes on her hands and feet, and cries of sore throat, abdominal pain and headache. Since there were cases of hand, foot and mouth disease in Wen’s kindergarten, it was highly suspected that Wen had hand, foot and mouth disease combined with viral encephalitis, but further examination was needed.
II. Treatment history
Through blood pressure tests and routine blood and cerebrospinal fluid examinations, Wen was found to have high blood pressure and elevated white blood cell count, mainly lymphocytes. The cerebrospinal fluid cell count was elevated, mainly mononuclear cells, and the CT of the brain revealed abnormal high signal in the right anterior temporal lobe, which, together with Wen’s symptoms, confirmed the diagnosis of HFMD combined with viral encephalitis. After communicating with Wen’s father, I treated her with the antiviral drug ribavirin injection, the cranial pressure-lowering drug mannitol injection, short-term hydrocortisone injection as appropriate, a full dose of intravenous human immunoglobulin (pH 4) and symptomatic support therapy. Wen’s father’s consent was obtained and the medication was started. On the 4th day of drug treatment, the condition improved, and the symptoms basically disappeared after 1 week, and the patient was discharged from the hospital for recuperation during the recovery period.
III. Treatment effect
On the day of treatment, the symptoms of sore throat, abdominal pain and headache began to reduce, and on the 4th day, Wen Wen’s body temperature and blood pressure returned to normal, herpes gradually subsided, headache, vomiting and abdominal pain disappeared. 1 week later, herpes on hands and feet and throat basically subsided when discharged from the hospital, and there was no abnormality in physical examination. 2 weeks later, the blood routine and biochemical indexes were not abnormal when re-examined, and the condition completely recovered and self-isolation was released.
Precautions
It is a good thing that Wen is gradually recovering and can be discharged home to recuperate, and I am happy for her and her family. During the home isolation period, parents need to monitor Wen’s medication, increase her activity and exercise during the recovery period. In addition, you should clean your hands well, avoid eating raw and cold food, and disinfect toys and objects that you have touched.
V. Personal insight
Hand, foot and mouth disease is often prevalent in kindergartens because it is easily transmitted among young children. Infection can be followed by herpes on the hands and feet, and in severe cases, it is accompanied by viral encephalitis. As in the case of 5-year-old Wen, HFMD was complicated by viral encephalitis, with symptoms such as headache, vomiting and shaking limbs, but the good thing is that early detection and early treatment therapy prevented the situation from becoming serious and life-threatening or leaving neurological sequelae. If you find your child in such a situation, you must seek medical treatment in a timely manner to avoid the continued progress of the disease leading to serious conditions.