Category: Clinical Sciences/Health Conditions
Case Diagnosis: Acute Flaccid Myelitis due to Enterovirus Transverse Myelitis and Meningoencephalitis
Case Description: The patient is a 33-year-old female with a history of rheumatoid arthritis, on immunosuppressive therapy with rituximab. She initially presented with lower extremity pain, but declined neurologically rapidly with encephalopathy, aphonia, diplopia, dysarthria, dysphasia, flaccid tetraparesis, and respiratory failure requiring mechanical ventilation. She was ultimately diagnosed with acute flaccid myelitis (AFM) and treated with IVIG (off-label) and fluoxetine (off-label). Enterovirus A71 was detected in the patient’s CSF and stool. Following acute care hospitalization, the patient was at a modified to complete dependence level of function. Thus, she was admitted to an acute inpatient rehabilitation unit for comprehensive rehabilitation. Fourteen days later, the patient discharged home at a modified to complete independence level of function.
Discussions: AFM is a rare condition, especially in adults; though, as evidenced by this patient, can be associated with immunosuppression. Functional outcomes have not been well studied in adults, and, to our knowledge, this report is the first review of an adult with the disease in an inpatient rehabilitation setting.
Conclusions: This report highlights the clinical manifestations of AFM in adults, as well as provides an understanding of potential outcomes associated with the disease when a patient is engaged in comprehensive acute inpatient rehabilitation.
William Niehaus– Associate Program Director, CU Physical Medicine and Rehabilitation Residency
Vera Staley– Resident Physician, University of Colorado
Jordan Wyrwa– Resident Physician, University of Colorado
Deanna Claus– Medical Student, University of Colorado School of Medicine
Rosa Malloy-Post– Medical Student, University of Colorado School of Medicine