[P2-19] A child case of Hopkins syndrome associated with Coxsackie A19 infection
Hopkins syndrome is a poliomyelitis-like illness manifesting flaccid paralysis affecting one or more extremities after an asthma attack. Although a viral infection or immune dysregulation during an attack of bronchial asthma has been proposed to be the mechanism involved in this syndrome, the precise pathogenesis remains unknown. We report a 5-year-old girl who showed paralysis and weakness of the muscle after severe acute bronchial asthma attack. Following corticosteroid infusion therapy for major asthmatic symptoms, she developed acute flaccid paralysis of the both lower extremities during recovery phase. Central spinal fluid examination on 9 day of illness showed mild pleocytosis with normal protein level, and high level of myelin basic protein. Using PCR analysis, Coxsackie A19(CA19) was detected in her spinal fluid. An electromyogram revealed a partial axonal lesion (normal motor nerve conduction velocity with low amplitude and absent of F-waves) of tibial nerves of the both legs, with normal sensory nerve conduction. Spinal cord MRI image showed localized high signal intensity lesion involving anterior horns. We began therapy with intravenous immunoglobulin for 5 consecutive days, additional steroid therapy. Afterward, she recovered a left leg but remain monoplegia of a right leg.This report contributes to understanding the role of viral immune-mediated mechanisms in the pathogenesis of this disease.