1.Infectious Diseases Unit, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisboa;
2. Pediatric Neurology Service, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisboa;
3. Neurorradiology Department, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisboa;
- 34th Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID) 2016, 10-14/05/2016, Brighton, United Kingdom (Poster)
Introdution: Adenoviruses cause a wide spectrum of illnesses in children, most commonly respiratory infections and acute gastroenteritis. Neurologic manifestations are uncommon.
Case Presentation: Previously healthy 17-month-old male, presenting periods of irritability followed by prostration, inability to stay seated and imbalance when standing. Four days prior, he had had a viral upper respiratory infection. The neurologic examinaton revealed torticollis to the left, reached objects preferably with left arm, and had a right sided brachial and facial hemiparesis. Trauma, accidental intoxication were excluded. Initial blood test showed leukocytosis (18700 cells/mm3), c-reactive protein of 18.3 mg/dL and normal cerebrospinal fluid (CSF). Brain and spinal magnetic resonance imaging (MRI) unveiled a T2-hyperintense intramedullary lesion, extending from C2-C3 until D9, involving preferably the posterior collumns, compatible with acute longitudinally extensive transverse myelitis (TM). Acute disseminated encephalomyelitis (ADEM) was considered unlikely regarding the continuity of the lesion and absence of brain lesions. The etiologic research revealed an acute adenovirus infection and other etiologies, namely auto-immune and metabolic were excluded. Polimerase Chain Reaction (PCR) for adenovirus was positive in respiratory secretions and other specimens (stool, CSF) were negative. High-dose methylprednisolone during 5 days was given with favourable response and was revaluated after 3 months maintaining excellent evolution.
Commentaries: Acute TM, rare in childhood, can be caused by various disorders including trauma, space occupying lesions, vascular malformations, infarction, autoimmunity and infections.In parainfectious TM, 20 to 40% of patients have preceding or concurrent viral infection. The association of adenovirus infection and transverse myelitis is extremely rare.
Palavras Chave: Adenovirus, children, myelitis