Abstract Details

Title A pediatric case of Coxsackie A virus rhombencephalitis

Topic Infectious Disease

Presentation(s) P11 - Poster Session 11 (8:00 AM-9:00 AM)

Poster/Presentation
Number 13-008

Objective To report a case of infectious rhombencephalitis caused by Coxsackie A virus treated with Intravenous Immunoglobulin (IVIG).

Background Rhombencephalitis is a rare neurologic condition that can be caused by both bacterial and viral agents including Listeria monocytogenes, Enterovirus 71 and Coxsackie A16. There is no consensus treatment for this disease process but IVIG has been used in Taiwan for Enteroviral rhombencephalitis with favorable results. Earlier administration of IVIG is found to prevent progression to pulmonary edema.

Design/Methods

Chart Review

Results

A 2 year old African American male with obstructive hydrocephalus status post endoscopic third ventriculostomy (ETV) 7 months prior presented with fever, vomiting and intermittent diarrhea concerning for a viral illness. On day 4 of hospitalization, he developed a perioral, truncal and acral maculopapular erythematous rash followed by new onset ataxia and a left beating horizontal torsional nystagmus which preceded rapid cardiopulmonary decline due to septic shock. He was stabilized and empirically treated with broad spectrum antimicrobials until negative blood and cerebrospinal fluid (CSF) cultures resulted.

Brain MRI showed diffusion restriction in the bilateral basal ganglia, pons and middle cerebellar peduncles. Spine MRI was normal. CSF analysis showed a lymphocytic pleocytosis with normal protein and glucose. Bacterial antigen panel and enterovirus PCR were both negative. Serology was strongly positive for Coxsackie A virus. The diagnosis of Coxsackie A rhombencephalitis was made. Patient received a 2-day course of IVIG without complications. He improved from a cardiopulmonary perspective within a few days. At the time of discharge he had a persistent but improving left hemiparesis and ataxia.

Conclusions

Enteroviruses are commonly encountered in pediatric populations, usually causing self-limited febrile illnesses such as gastroenteritis, rarely progressing to significant neurological disease such as rhombencephalitis. Early administration of IVIG may be beneficial to prevent evolution to cardiopulmonary collapse.

Authors/Disclosures
Neel Fotedar, MD (University Hospitals Cleveland Medical Center) PRESENTER	Dr. Fotedar has received research support from NINDS.
Kendall Wyllie, MD (Banner University Medical Center)	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Jessica H. Goldstein, MD, F�鶹��ýӳ��	Dr. Goldstein has nothing to disclose.

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