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

## TL;DR

A 6-year-old boy with Coxsackievirus A6 infection developed severe hand foot mouth disease leading to fatal cerebral edema and cardiopulmonary arrest.

## Contribution

This case report highlights CV-A6 as a rare but severe cause of fulminant cerebral edema in hand foot mouth disease.

## Key findings

- CV-A6 infection can cause severe neurological complications including fulminant cerebral edema.
- A 6-year-old patient with CV-A6 developed fatal outcomes despite medical intervention.
- CV-A6 is increasingly the main pathogen for hand foot mouth disease in China.

## Abstract

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.

In recent years, coxsackievirus (CV)‐A6 has gradually replaced enterovirus 71 and CV‐A16 as the primary pathogen causing hand, foot, and mouth disease. The majority of CV‐A6 infections are mild cases, but a very small number of patients with CV‐A6 infection can develop acute fulminant cerebral edema, which can have fatal consequences.