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Pediatric Acute Flaccid Paralysis: Enterovirus D68-Associated Anterior Myelitis.

Authors
  • Yoder, James A1
  • Lloyd, Michael2
  • Zabrocki, Luke3
  • Auten, Jonathan1
  • 1 Department of Emergency Medicine, Naval Medical Center, Portsmouth, Virginia.
  • 2 School of Medicine, Eastern Virginia Medical School, Norfolk, Virginia.
  • 3 Department of Pediatrics, Naval Medical Center, San Diego, California.
Type
Published Article
Journal
The Journal of emergency medicine
Publication Date
Jul 01, 2017
Volume
53
Issue
1
Identifiers
DOI: 10.1016/j.jemermed.2017.03.020
PMID: 28412073
Source
Medline
Keywords
License
Unknown

Abstract

A fully immunized 8-year-old boy was brought to the emergency department complaining of a cough, headache, neck pain, and right arm pain and weakness. Deep tendon reflexes in the weak arm could not be elicited. MRI of the brain and cervical spine revealed anterior myelitis of the cervical spine. The patient was given intravenous antibiotics, acyclovir, and methylprednisolone with no initial improvement. He was then given intravenous immunoglobulin over 3 days with improvement in symptoms. Nasal swab polymerase chain reaction revealed EV-D68. Despite medical management, the child was left with long-term motor disability in the effected extremity. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Acute flaccid paralysis is a potential devastating complication of enteroviral infections. Extremity complaints in the clinical setting of central nervous system infection should raise concern for encephalomyelitis. MRI is extremely helpful in establishing this diagnosis. Prevalence of non-polio enteroviral paralytic events is increasing in the United States. Potential EV-D68 cases should be reported to local health departments. Emergency medicine providers should consider this complication in the child with acute, unexplained significant respiratory illness with new neurologic complaints.

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