Title: Child with Acute Flaccid Myelitis presenting as Upper Limb Monoperesis
Authors: Dr Gaurav Sharma, Dr Richa Sharma, Dr Pallavi Sharma, Dr Garima Sharma
DOI: https://dx.doi.org/10.18535/jmscr/v11i5.15
Abstract
Introduction
Acute flaccid myelitis (AFM) is a neurologic illness of sudden onset in children. It presents with localised limb weakness of unknown cause. Enterovirus 68, which as a member of the enterovirus family related to polio, and is a leading candidate for the cause of the condition.
Since August 2014, CDC has been made aware of an increased number of people across the United States with AFM for which no cause could be found. Since then, CDC has been actively investigating this illness. In 2016, a total of 144 people in 37 states across the country were confirmed to have AFM.
Case Report
A 13 year old adolescent male presented with fever and cough for 3 days followed by pain in the neck and shoulder and sudden weakness of right upper limb. The weakness was noticed early morning on the 4th day of illness when the child was not able to move his right limb, he could not button up his clothes and comb his hair with his right hand. All the other limbs were normal. On history the following findings were noted
References
- AFM in the United States. https://www.cdc.gov/acute-flaccid-myelitis/afm-surveillance.html (Accessed on April 06, 2017).
- Lang M, Mirand A, Savy N, et al. Acute flaccid paralysis following enterovirus D68 associated pneumonia, France, 2014. Euro Surveill 2014; 19.
- Crone M, Tellier R, Wei XC, et al. Polio-Like Illness Associated With Outbreak of Upper Respiratory Tract Infection in Children. J Child Neurol 2016; 31:409.
- Pfeiffer HC, Bragstad K, Skram MK, et al. Two cases of acute severe flaccid myelitis associated with enterovirus D68 infection in children, Norway, autumn 2014. Euro Surveill 2015; 20:21062.
- Williams CJ, Thomas RH, Pickersgill TP, et al. Cluster of atypical adult Guillain-Barré syndrome temporally associated with neurological illness due to EV-D68 in children, South Wales, United Kingdom, October 2015 to January 2016. Euro Surveill 2016; 21.
- Yea C, Bitnun A, Robinson J, et al. Longitudinal Outcomes in the 2014 Acute Flaccid Paralysis Cluster in Canada. J Child Neurol 2017; 32:301.
- Van Haren K, Ayscue P, Waubant E, et al. Acute Flaccid Myelitis of Unknown Etiology in California, 2012-2015. JAMA 2015; 314:2663.
- Messacar K, Schreiner TL, Van Haren K, et al. Acute flaccid myelitis: A clinical review of US cases 2012-2015. Ann Neurol 2016; 80:326.
- Centers for Disease Control and Prevention. Acute flaccid myelitis investigation: For clinicians. www.cdc.gov/ncird/investigation/viral/2014-15/hcp.html (Accessed on January 06, 2016).
- Centers for Disease Control and Prevention. Acute flaccid myelitis: interim considerations for clinical management. www.cdc.gov/ncird/downloads/acute-flaccid-myelitis.pdf (Accessed on November 21, 2014).
- Messacar K, Schreiner TL, Maloney JA, et al. A cluster of acute flaccid paralysis and cranial nerve dysfunction temporally associated with an outbreak of enterovirus D68 in children in Colorado, USA. Lancet 2015; 385:1662.