case_images: PMC11148355_01
case_images: Chest and abdominal radiographs on DOH 1 (A), DOH 4 (B), DOH 6 (C), DOH 8 (D), DOH 10 (E), DOH 12 (F), DOH 19 (G) and DOH 21 (H). Increasingly intensified pulmonary edema, disappeared intestinal tube aeration and accumulated ascites (A-C), gradually subsided pulmonary edema, recovered intestinal tube aeration and absorbed ascites (D-F), enlargement of the heart shadow, relatively clear lung field and well-inflated intestinal tube (G,H). DOH, day of hospitalization.
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case_images: PMC11148355_01_fcvm-11-1364289-g001.jpg
case_images: F1
case_images: He had recurrent fever (peaked at 38.2 C), weak heart sounds (DOH 2), aggravated coma (DOH 3), obvious abdominal distension, gradual hepatomegaly to 4 cm (DOH 3), absent bowel sounds (DOH 4), systemic edema (DOH 4), exacerbation of pulmonary edema, decreased intestinal inflation, increased ascites (Figures 1A,B), oliguria (DOH 4, Table 1), transient supraventricular tachycardia and ventricular fibrillation (DOH 3), ST-segment depression in lead V1 and V3, and heart failure. His left ventricular ejection fraction (LVEF) and fractional shortening (FS) dipped as low as 40% and 18%, respectively (Table 1), with positive anal swab enterovirus ribonucleic acid (DOH 2), and markedly raised lactate (maximum value 8.4 mmol/L), creatine kinase-MB (CK-MB, maximum value 405.8 U/L), cardiac troponin I (cTnI, maximum value 25.85 ng/ml), and N-terminal pro-brain natriuretic peptide (NT-proBNP > 35,000 ng/L throughout hospitalization) (Table 1). After ECMO support (pump flow 0.4-0.45 L/min) with continuous sedation (midazolam), analgesia (sufentanil), and muscle relaxation (vecuronium bromide), he was no longer feverish with renormalization of urine volume (Table 1) and significant reduction of systemic edema (DOH 9) and pulmonary edema (Figures 1C,D), and abdominal bloating subsided on DOH 9, though there were weak heart sounds, a 3 cm hepatomegaly, no bowel sounds and intestinal inflation, persistent ascites despite timely abdominal drainage via vein detained needle (24 G) on the afternoon of DOH 6 without complications, and bilateral renal enlargement detected by point-of-care ultrasonography (POCUS) (DOH 5). Soft tissue edema (DOH 11), pulmonary edema (Figures 1E,F), and ascites (Figures 1E,F) gradually subsided. His consciousness, heart sounds (DOH 11), bowel sounds (DOH 13), liver (DOH 13), kidneys (DOH 12), intestinal inflation (Figures 1E,F), and electrocardiogram were restored, and bilateral IVH did not progress. Figure 1H) showed no significant change compared to Figure 1G. Finally, the patient was discharged on DOH 26.
case_images: Parasternal left ventricle long axis view of transthoracic echocardiograms on PND 41 (A), PND 85 (B), PND 498 (C), and PND 1,084 (D), illustrating diffuse hyperechogenic foci of the interventricular septum (arrows). PND, postnatal day.
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case_images: PMC11148355_01_fcvm-11-1364289-g002.jpg
case_images: F2
case_images: Table 1), FS (PND 56, Table 1), and heart size (PND 85) gradually normalized, and NT-proBNP decreased to 760.8 ng/L (PND 70, Table 1). There were no other abnormalities aside from interventricular septum hyperechogenic foci (Figure 2) and mild mitral/tricuspid regurgitation, and the former had become less pronounced by PND 1,084 (Figure 2D).