Rodesch Marine, Sculier Claudine, Lolli Valentina, Remiche Gauthier, Delpire Iris, Fricx Christophe, Vermeulen Françoise, Christiaens Florence
Department of Pediatrics, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.
Department of Neuropediatrics, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.
Case Rep Neurol. 2024 Jan 31;16(1):41-47. doi: 10.1159/000535316. eCollection 2024 Jan-Dec.
We describe the first case of acute flaccid myelitis (AFM) related to enterovirus D68 (EV-D68) infection in Belgium. The clinical and radiological presentation of AFM associated with EV-D68 although well described currently remains a challenging diagnosis. Through this interesting clinical case, we aimed to review the differential diagnosis of acute flaccid palsy in a child and discuss the specific point of interest related to AFM.
We present the case of a 4-year-old girl with a torticollis associated with an acute palsy of the right upper limb. The magnetic resonance imaging revealed an increased T2 signal intensity of the entire central gray matter of the cervical cord with involvement of the posterior brainstem. A polymerase chain reaction (PCR) conducted on a nasopharyngeal swab was found positive for EV-D68. The definition of AFM proposed by the Center for Disease Control and Prevention (CDC) is an acute-onset flaccid weakness of one or more limbs in the absence of a clear alternative diagnosis and the radiological evidence of gray matter involvement on an MRI picture, and our case fits these two criteria. A prompt and detailed workup is required to distinguish this emergent disease from other forms of acute flaccid palsy. The functional prognosis of AFM is poor, and there are no evidence-based treatment guidelines so far.
AFM is an emerging pathology that requires the attention of pediatricians to quickly rule out differential diagnoses and adequately manage the patient. Further research is needed to optimize treatments, improve outcomes, and provide scientifically based guidelines.
我们描述了比利时首例与肠道病毒D68（EV - D68）感染相关的急性弛缓性脊髓炎（AFM）病例。尽管目前对与EV - D68相关的AFM的临床和放射学表现已有详细描述，但它仍然是一个具有挑战性的诊断。通过这个有趣的临床病例，我们旨在回顾儿童急性弛缓性麻痹的鉴别诊断，并讨论与AFM相关的特殊关注点。
我们呈现了一名4岁女孩的病例，她患有斜颈并伴有右上肢急性麻痹。磁共振成像显示颈髓整个中央灰质的T2信号强度增加，且累及脑干后部。对鼻咽拭子进行的聚合酶链反应（PCR）检测发现EV - D68呈阳性。疾病控制与预防中心（CDC）提出的AFM定义为在没有明确的其他诊断且MRI图像上有灰质受累的放射学证据的情况下，一个或多个肢体急性发作的弛缓性无力，我们的病例符合这两个标准。需要迅速且详细的检查来将这种急症与其他形式的急性弛缓性麻痹区分开来。AFM的功能预后较差，并且目前尚无基于证据的治疗指南。
AFM是一种新出现的病症，需要儿科医生予以关注，以便快速排除鉴别诊断并对患者进行适当管理。需要进一步研究以优化治疗、改善预后并提供基于科学的指南。
