Human parechovirus meningoencephalitis in a newborn: a case report

Introduction. Human parechovirus (HPeV) is an increasingly recognized cause of sepsis-like illness and central nervous system infection in neonates. The clinical presentation is often nonspecific and may mimic bacterial sepsis, making early diagnosis challenging. Case presentation. We report the case of a six-day-old female infant who presented with fever (38.5°C), poor feeding, lethargy, and irritability. Initial laboratory investigations demonstrated a mildly elevated C reactive protein (CRP) level, while blood cultures, urine cultures, respiratory viral testing, and umbilical stump cultures were negative. Transfontanellar ultrasonography showed no significant abnormalities. Cerebrospinal fluid (CSF) analysis revealed normal cytology and glucose levels. A multiplex PCR meningitis/encephalitis panel performed on the CSF detected human parechovirus, establishing the diagnosis of parechovirus meningoencephalitis. Empirical treatment with ceftazidime and ampicillin was initiated upon admission and continued after the etiological diagnosis. Dexamethasone, together with supportive therapy, was subsequently added to the treatment regimen. The patient showed progressive clinical improvement, with normalization of inflammatory markers, and was discharged after nine days of hospitalization without neurological impairment. Conclusion. This case highlights the importance of considering human parechovirus infection in neonates presenting with fever and sepsis-like symptoms, even when conventional microbiological investigations and CSF findings are unremarkable. Early molecular diagnostic testing using multiplex PCR from CSF plays a crucial role in establishing the diagnosis and guiding clinical management.