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563 Case Report: Transverse Myelitis Caused by Enterovirus Infection
  1. BES Araujo,
  2. APDC Dalcol,
  3. A Vasconcellos,
  4. SHS Victal,
  5. AC Seabra
  1. Cetipen, Hospital Central da Policia Militar Rio de Janeiro, Rio de Janeiro, Brazil

Abstract

Background and Aims Enterovirus infections are most common in young children, and acute infection of the CNS occurs at all ages. Meningitis is by far the most common CNS manifestation. Certain enteroviruses (ie, polioviruses, enterovirus 71) preferentially target the motor nuclei and anterior horn cells of the brain and spinal cord, causing acute paresis of cranial and spinal nerves.

Our objective is report an uncommon case of a teenage girl with transverse myelitis caused by enterovirus infection whose obtained good outcome after plasmapheresis treatment.

Methods Report case.

An 11 years old girl with lower limb paresthesia, are flexia, hypotony, evolving with bladder’s urine retention, paresis and respiratory effort about 10 days. The liquor exam was positive for enterovirus PCR (polymerase chain raction) and thoraco - lumbar NMR revelead transverse myelitis involving C3 and L4 level.

Results First treatment was initiated with 2 immunoglobulin’s cycles and pulse therapy with methylprednisolone not getting satisfactory motor response. The patient developed with respiratory effort and hypoventilation (PCO2 max - 90mmHg) becoming necessary to introduce a course of 5 days of non invasive ventilation. Subsequently, a 5-day plasmapheresis cycle was iniciated, solving the clinical case with an increasing recovering of motor and ventilation function after 1 week of treatment.

Conclusion Enterovirus infections can cause several clinical manifestations such as transverse myelitis. In most of tranverse myelitis cases the treatment is immunoglobulin and pulse therapy with methylprednisolone, yet this case was only solved after plasmapheresis cycle.

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