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Journal of the Korean Child Neurology Society 2013;21(3):208-212.
Published online September 30, 2013.
A Case of Combined Acute Disseminated Encephalomyelitis and Acute Flaccid Paralysis associated with Enteroviral Infection.
Jungjin Lee, Youjin Choi, Seonkyeong Rhie, Sun Jung Jang, Kyu Young Chae
Department of Pediatrics, CHA Bundang Medical Center, CHA University, Korea. danielchae21@gmail.com
Abstract
Enterovirus infection is often aggravated and manifests as various neurological complications such as aseptic meningitis, brainstem encephalitis, poliomyelitis-like acute flaccid paralysis, transverse myelitis, and severe systemic diseases. There are a few reports indicating that enterovirus is associated with acute disseminated encephalomyelitis (ADEM), acute flaccid paralysis, or Guillain-Barre syndrome separately. However, none of these report ADEM and acute flaccid paralysis occurring simultaneously. Here, we present a case of combined ADEM and acute flaccid paralysis associated with enteroviral infection in a child and reviewed the relevant literature. A 5-year-old boy was admitted to the hospital for headache and vomiting with evident meningeal irritation signs. Despite of antibiotic therapy, his mental state rapidly declined to coma with abnormal upper motor neuron (UMN) signs. During 5 consecutive days of steroid pulse therapy, his abnormal UMN signs abruptly changed to flaccid paralysis. Suspected acute flaccid paralysis due to enterovirus prompted the addition of intravenous immunoglobulin (IVIG). On hospital day 33, he was discharged with full recovery of muscle tone and strength with an alert mental state.
Key Words: Encephalomyelitis, Acute Disseminated, Muscle Hypotonia, Attention Deficit Disorder with Hyperactivity, Enterovirus


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