Advertisement

Springer Nature is making Coronavirus research free. View research | View latest news | Sign up for updates

Acute flaccid myelitis temporally associated with rhinovirus infection: just a coincidence?

Abstract

We report the case of a 3.6-year-old male child who developed progressive hyposthenia of the left lower limb. Symptoms were preceded by rhinitis, malaise, and fever. Brain and spinal magnetic resonance imaging revealed diffuse signal abnormalities compatible with a subacute myeloencephalitis. A diagnostic lumbar puncture was performed and followed by an empirical therapy including Acyclovir, Ceftriaxone, and Clarithromycin. The cerebrospinal fluid analysis revealed clear fluid, glucose, proteins, albumin within the reference range, and 144 leukocytes/mm3. Oligoclonal bands were absent and a search for viruses was negative. Wide microbiological surveillance was performed on surface swabs, blood, urine, and stool. Both nasal and pharyngeal swabs were positive for PicoRNAvirus: sequencing identified Rhinovirus A44. This virus has been detected in association with acute flaccid paralysis in only a few patients worldwide, whereas in the great majority of patients with acute flaccid paralysis other Enterovirus species were identified. The most appropriate therapeutic approach towards acute flaccid paralysis is still a matter of debate in the scientific community, with no current definitivere commendations available. With a combined immunosuppressive and anti-inflammatory therapy including intravenous immunoglobulins, intravenous Methylprednisolone, oral Prednisone, and oral Ibuprofen, we experienced a positive outcome both from the clinical point of view and from three-month follow-up imaging studies. Given the rarity and the complexity of this condition, additional studies are needed to better define the potential role of Rhinovirus A44 in the pathogenesis of the disease and the efficacy of any therapeutic measure in the management of acute flaccid paralysis.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Andersen EW, Kornberg AJ, Freeman JL, Leventer RJ, Ryan MM (2017) Acute flaccid myelitis in childhood: a retrospective cohort study. Eur J Neurol 24(8):1077–1083. https://doi.org/10.1111/ene.13345

  2. 2.

    Messacar K, Schreiner TL, Van Haren K, Yang M, Glaser CA, Tyler KL, Dominguez SR (2016) Acute flaccid myelitis: A clinical review of US cases 2012-2015. Ann Neurol 80(3):326–338. https://doi.org/10.1002/ana.24730

  3. 3.

    Nelson GR, Bonkowsky JL, Doll E, Green M, Hedlund GL, Moore KR, Bale JF (2016) Recognition and management of acute flaccid myelitis in children. Pediatr Neurol 55:17–21. https://doi.org/10.1016/j.pediatrneurol.2015.10.007

  4. 4.

    Ruggieri V, Paz MI, Peretti MG, Rugilo C, Bologna R, Freire C, Vergel S, Savransky A (2017) Enterovirus D68 infection in a cluster of children with acute flaccid myelitis, Buenos Aires, Argentina, 2016. Eur J Paediatr Neurol 21(6):884–890. https://doi.org/10.1016/j.ejpn.2017.07.008

  5. 5.

    Bitnun A, Yeh EA (2018) Acute flaccid paralysis and enteroviral infections. Curr Infect Dis Rep 20(9):34. https://doi.org/10.1007/s11908-018-0641-x

Download references

Author information

Correspondence to Silvia Ferranti.

Ethics declarations

The authors declare that they have no conflict of interest. The authors received no funding for this work. The work described has not been published before and it is not under consideration for publication anywhere else. Its publication has been approved by all co-authors, as well as by the responsible authorities at the institute where the work has been carried out. Informed consent was obtained from the patient’s parents.

Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Coriolani, G., Ferranti, S., Biasci, F. et al. Acute flaccid myelitis temporally associated with rhinovirus infection: just a coincidence?. Neurol Sci 41, 457–458 (2020). https://doi.org/10.1007/s10072-019-04094-w

Download citation

Keywords

  • Acute flaccid paralysis
  • Acute flaccid myelitis
  • Rhinovirus
  • Myeloencephalitis