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Journal of the American College of Emergency Physicians Open logoLink to Journal of the American College of Emergency Physicians Open
. 2024 Oct 21;5(5):e13323. doi: 10.1002/emp2.13323

Young infant with umbilical protrusion

Yuto Otsubo 1,2,, Ryoichi Yamaki 3, Yuho Horikoshi 1,2
PMCID: PMC11492402  PMID: 39435326

1. PATIENT PRESENTATION

A 1‐month‐old male infant presented to a pediatric emergency department with a fever and poor activity. Physical examination revealed tachycardia, slightly mottled skin, abdominal distension, and an umbilical protrusion (Figure 1).

FIGURE 1.

FIGURE 1

The umbilical protrusion, abdominal distension, and slightly mottled skin.

2. DIAGNOSIS: HUMAN PARECOVIRUS TYPE 3 INFECTION (HPeV3)

The symptom of umbilical protrusion raised the suspicion of a HPeV3 infection, polymerase chain reaction was performed, and HPeV was detected in the cerebrospinal fluid. A type analysis revealed HPeV3. His general condition, including the umbilical protrusion, resolved after a few days.

HPeV3 can cause a severe infection, such as sepsis or a central nervous system infection, in a young infant. 1 Early diagnosis, though difficult, can enable the discontinuation of unnecessary antibiotic therapy and help predict the clinical course of the infection.

Umbilical protrusion is one of the characteristic symptoms of early infantile HPeV3 infection. In a previous study, eight of 43 young infants with HPeV3 (19%) presented with an umbilical protrusion. 2 Umbilical protrusion is typically observed in the presence of abdominal distention. 3 Abdominal distension caused by HPeV3 is sometimes severe and may be confused with a surgical condition. 4 The mechanism of umbilical protrusion is thought to be an increased abdominal pressure and the insufficient development of the umbilical ring in young infants. In young infantile cases of abdominal distention and umbilical protrusion accompanied by sepsis‐like symptoms, HPeV3 should be considered in a differential diagnosis.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

FUNDING INFORMATION

There were no sources of funding for this study.

ACKNOWLEDGMENTS

We would like to thank James R. Valera for his editorial assistance and Dr. Yuta Aizawa of the Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan for his serotype analysis of human parechovirus.

Otsubo Y, Yamaki R, Horikoshi Y. Young infant with umbilical protrusion. JACEP Open. 2024;5:e13323. 10.1002/emp2.13323

REFERENCES

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