Acute Flaccid Paralysis in Single Upper Limb with HFMD from Enterovirus71 Infection: Case Report and Review of the Literature

1 Department of Pediatrics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand

Affiliation : Sudarat Charoensanti MD1

Background : Human enterovirus71 [EV71] infection caused hand-foot-mouth disease [HFMD]. Although most of the symptoms are mild with fever and painful vesicular lesions on the hands, mouth, and oral mucosa, some patients developed serious neurological complications including acute brain stem encephalitis, aseptic meningitis, acute (cid:976)laccid paralysis [AFP] mimicking paralytic poliomyelitis, Guillain-Barre syndrome, transverse myelitis, and cerebellar ataxia. The worldwide eradication of poliomyelitis, EV71 is the one of important causes of AFP.
Objective : To report a 1-year-old male patient who developed AFP in upper limb two days after the onset of HFMD.
Case Report : EV71 was isolated from a stool specimen after two days onset of AFP. The spinal magnetic resonance imaging [MRI] indicated that there was long strip high signal on T2WI and low signal on T1WI in cervical spinal cord at the level of C3 to C6 levels on sagittal images and low signal on T1WI and high signal on T2WI in unilateral anterior horn. He was treated with vitamin B1-6- 12 and physical rehabilitation and still had residual motor weakness on proximal muscle at one-year follow-up.
Conclusion : EV71 infection was related to acute (cid:976)laccid poliomyelitis-like. MRI showed the damage at anterior horn of the spinal cord with clinical correlation. Prognosis was poor because there was no established anti-viral treatments or ancillary treatments available for EV71, resulting in persistent motor weakness at long-term follow-up. Multi-limb paralysis and limbs weakness distribution with both upper and lower limbs weakness is the clinical predictive prognosis.

Keywords : Enterovirus71, Acute (cid:976)laccid paralysis, Hand-foot-mouth disease, Neurological complication

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