Wissler's Syndrome Associated with Parainfluenza 2 Infection

Abstract

A 9-year-old boy fell ill with respiratory symptoms and high fever, followed after a day or so by acute pleuritis. A classical Wissler's syndrome developed with altogether 3 attacks of high fever within the course of a month, various forms of exanthema on 2 occasions, arthritis in knee-joint, leucocytosis with eosinophilia attaining an extreme degree, and a high erythrocyte sedimentation rate. Blood cultures were negative; and, through extensive bacteriological tests and serological reactions, infections with various bacteria, mycoplasma, psittacosis agent and ordinary respiratory virus could be excluded with the exception of parainfluenza 2, for which infection there was clear serological evidence. Urinary findings with abundance of inclusion-bearing cells and occurrence of multinuclear giant cells may be considered to confirm this diagnosis. Pulmonary infiltrates, appearing after the acute pleuritis had receded, were probably due to small primary bronchopneumonias caused by parainfluenza 2. Infiltrates appearing in the subsequent course without clinical symptoms are classified, on the other hand, as eosinophil pulmonary infiltrates. These, as well as the primary pleuritis, must be regarded as subsymptoms of Wissler's syndrome. Aetiologically, a bacterial cause has been sought for earlier. The present case, however, shows that Wissler's syndrome may be brought on by a virus infection. The clinical picture may possibly reflect an individual reaction of an allergic nature to various infections, both bacteriological and virological.