[P2-15] Acute Flaccid Paralysis in a Male Infant
[Introduction] Since summer 2015, Japan has seen a succession of cases presenting with common cold -like symptoms followed by acute flaccid paralysis (AFP) of unknown etiology. Enterovirus D68 (EV-D68) has been detected in some of these patients. Cases with similar neurological symptoms were reported in the United States in 2014, following a nationwide outbreak of EV-D68. This suggests a potential link between EV-D68 and AFP. We report the case of a 1-year-old boy with similar symptoms.
[Patient] Male infant, 14 months old. Delivered at term with no birth asphyxia. Motor development was normal.
[Present illness] He presented with fever, and admitted to our department on day 6 of illness due to weakness in the right leg.
[Initial examination] Lucid, with no abnormalities of the cranial nervous system. Deep tendon reflexes were absent in both legs, and the manual muscle test score for the right leg was 1/5.
Blood count and general biochemical tests were normal. Cerebrospinal fluid cell count and protein was 212/L and 43 mg/dL, respectively. Axonopathy was found in a nerve conduction velocity of the right tibia. Contrast-enhanced MRI of the spine revealed gadolinium enhancement of the ventral cauda equina.
[Clinical course] Gamma-globulin therapy and methylprednisolone pulse therapy was administered, but no change was seen in the right leg. He was discharged on day 45. EV-D68 was detected from stool samples taken on day 1 and 7 of AFP.
[Discussion] Treatment was similarly ineffective in previous cases, suggesting the potential for polio-like neuronophagia in this disease.
[Patient] Male infant, 14 months old. Delivered at term with no birth asphyxia. Motor development was normal.
[Present illness] He presented with fever, and admitted to our department on day 6 of illness due to weakness in the right leg.
[Initial examination] Lucid, with no abnormalities of the cranial nervous system. Deep tendon reflexes were absent in both legs, and the manual muscle test score for the right leg was 1/5.
Blood count and general biochemical tests were normal. Cerebrospinal fluid cell count and protein was 212/L and 43 mg/dL, respectively. Axonopathy was found in a nerve conduction velocity of the right tibia. Contrast-enhanced MRI of the spine revealed gadolinium enhancement of the ventral cauda equina.
[Clinical course] Gamma-globulin therapy and methylprednisolone pulse therapy was administered, but no change was seen in the right leg. He was discharged on day 45. EV-D68 was detected from stool samples taken on day 1 and 7 of AFP.
[Discussion] Treatment was similarly ineffective in previous cases, suggesting the potential for polio-like neuronophagia in this disease.