A one-year-old
girl visited the
hospital due to
limb torsion and developmental regression for one month after
hand, foot and mouth disease. At the age of 11 months, she visited a local
hospital due to
fever for 5 days and
skin rash with frequent convulsions for 2 days and was diagnosed with severe
hand, foot and mouth disease,
viral encephalitis, and
status epilepticus.
Brain MRI revealed symmetric abnormal signals in the bilateral
basal ganglia, bilateral
thalamus,
cerebral peduncle, bilateral cortex, and
hippocampus. She was given
immunoglobulin,
antiviral drugs, and
anticonvulsant drugs for 2 weeks, and the effect was poor.
Blood and
urine screening for inherited
metabolic diseases were performed to clarify the
etiology. The
analysis of
urine organic acids showed significant increases in glutaric
acid and 3-hydroxyglutaric
acid, which suggested glutaric aciduria type 1, but her
blood glutarylcarnitine was normal, and free
carnitine significantly decreased. After the
treatment with low-
lysine diets,
L-carnitine, and
baclofen for 1 month, the
patient showed a significant improvement in symptoms.
Hand, foot and mouth disease is a common viral
infectious disease in
children, and
children with underlying
diseases such as inherited
metabolic diseases and immunodeficiency may experience serious
complications. For
children with
hand, foot and mouth disease and unexplained
encephalopathy, inherited
metabolic diseases should be considered.