Atypical Presentations of Respiratory Syncytial Virus Infection: Case Series

Abstract

The respiratory syncytial virus (RSV) usually causes a lower respiratory tract infection in affected patients. RSV has also been infrequently linked to extrapulmonary diseases in children. We report four children who had unusually severe clinical manifestations of RSV infections requiring critical care admission. These patients presented to the Royal Hospital, Muscat, Oman, in December 2013 with acute necrotising encephalopathy (ANE), acute fulminant hepatic failure with encephalopathy, pneumatoceles and croup. A unique presentation of ANE has not previously been reported in association with an RSV infection. All patients had a positive outcome and recovered fully with supportive management.

Keywords: Case Series; Croup; Encephalitis; Epidemiology; Hepatitis; Oman; Respiratory Syncytial Virus Infections.

Figure 1 A&B:

Chest X-rays of an 11-month-old female infant (case one) with respiratory syncytial virus infection showing (A) right upper lobe consolidation and (B) complete consolidation resolution five days after admission.

Figure 2 A&B:

Chest X-rays of a nine-year-old boy (case two) with respiratory syncytial virus infection showing (A) upper airway narrowing which required (B) intubation.

Figure 3 A&B:

Chest X-rays of a 33-day-old male infant (case three) with respiratory syncytial virus infection showing (A) right-side pneumatoceles on admission and (B) the resolution of the pneumatoceles four days after admission.

Figure 4 A&B:

Axial fluid-attenuated inversion recovery magnetic resonance images of the brain in a six-year-old female (case four) with respiratory syncytial virus infection showing (A) non-confluent white matter hyperintense foci involving the centrum semiovale, periventricular white matter and internal capsules, (B) hyperintense lesions involving the anterior midbrain and (C) hyperintense lesions involving the cerebellar peduncles.