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A difficult case
Acute segmental poliomyelitis-like flaccid paralysis in an adult in the UK, associated with enterovirus D68
  1. Sybil R L Stacpoole1,2,
  2. Adam Molyneux2,
  3. Dirk Bäumer1,2
  1. 1 Department of Neurology, Peterborough City Hospital, Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, UK
  2. 2 Department of Neurology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  1. Correspondence to Dr Sybil R L Stacpoole, Department of Neurology, Peterborough City Hospital, Peterborough and Stamford Hospitals NHS Foundation Trust, Edith Cavell Campus, Bretton Gate, Bretton, Peterborough PE3 9GZ, UK; srls2{at}cam.ac.uk

Abstract

Enterovirus D68 has been associated with a poliomyelitis-like illness, notably during an outbreak in 2014, and particularly affecting children in the USA. We report a case of acute segmental flaccid paralysis with respiratory involvement in an adult in the UK, with enterovirus D68 detected in a sputum sample. MR imaging of cervical spinal cord showed a longitudinally extensive T2 hyperintensity in the anterior cord. Cerebrospinal fluid showed an elevated white cell count, predominantly lymphocytic, with otherwise normal constituents and negative viral PCRs. His respiratory function improved after intravenous immunoglobulin, suggesting that this may be useful in such cases. Clinicians should consider enterovirus D68 infection in the differential diagnosis of Guillain-Barré syndrome, particularly the pharyngeal–cervical–brachial variant.

  • CLINICAL NEUROLOGY
  • GUILLAIN-BARRE SYNDROME
  • INFECTIOUS DISEASES
  • MYELOPATHY
  • NEUROVIROLOGY

https://doi.org/10.1136/practneurol-2017-001609

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    Footnotes

    • Acknowledgements We thank Dr Justin Cross, consultant neuroradiologist, for his review of the MRI.

    • Contributors SRLS is the lead writer of the report and is the consultant neurologist responsible for the initial care of the patient. AM undertook the neurophysiological investigations, commented on the report and prepared Supplementary tables. DB contributed to writing the report, took over follow-up of the patient and provided the images.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed. This paper was reviewed by Nick Davies, London, UK.

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