Posters
The Various Clinical Presentations of Acute Flaccid Myelitis and Initial Treatment Responses
Presenting Author Academic/Professional Position
Medical Student
Academic Level (Author 1)
Medical Student
Academic Level (Author 2)
Other
Discipline/Specialty (Author 2)
Pediatrics
Presentation Type
Poster
Discipline Track
Patient Care
Abstract Type
Case Report
Abstract
Background Acute Flaccid Myelitis (AFM) is a neurological disorder primarily affecting children, characterized by sudden muscle weakness or paralysis due to inflammation in the spinal cord's anterior horn cells. Often associated with viral infections, particularly enterovirus D68, AFM presents with variable symptoms and requires specific MRI findings for diagnosis. The CDC began tracking AFM in 2014, noting a biannual spike in cases during late summer, which aligns with an uptick in cases observed this past summer at our tertiary care children's hospital. In 2023, the U.S. reported 18 AFM cases, including three in Texas. Treatment options include intravenous immunoglobulin (IVIG), high-dose steroids, and plasmapheresis, although there is no definitive evidence supporting the superiority of any treatment. A recent study indicated that most patients experience some level of impairment 12 months post-diagnosis, highlighting the need for effective management and improved understanding of AFM’s long-term impact.
Summary of Cases
- Patient 1: A 3-year-old girl with no prior medical issues presented in late summer with left upper extremity weakness following a 5-day history of respiratory symptoms. MRI revealed signs consistent with AFM, and the patient tested positive for rhinovirus/enterovirus. She received high dose methylprednisone for five days and physical therapy. By discharge, her strength had improved significantly, with her left hand reaching 4/5 strength.
- Patient 2: A 2-year-old girl, admitted to the PICU in early fall with sudden onset paralysis, experienced rapid loss of movement in all four extremities. Despite normal MRI findings, her spinal cord MRI showed edema from the skull base to T4. She tested positive for multiple respiratory viruses. She was intubated for eight days and treated with steroids and IVIG. After two weeks, she showed gradual improvement in muscle function and was transferred to a rehabilitation facility.
- Patient 3: A 2-year-old girl presented in early fall with ascending paralysis, starting with fever and cough. She had difficulty with facial movements and minimal strength in her extremities. MRI of the spinal cord showed mild T2 hyperintensity from C2 to C7. She was intubated for respiratory support and treated with steroids and IVIG. Despite no significant improvement, she underwent plasmapheresis, which had to be stopped due to hypotension. She remained intubated, continuing physical and occupational therapy.
Conclusions This case series highlights the diverse clinical presentations and responses to treatment observed in AFM cases at a tertiary children’s hospital. The patients’ outcomes varied significantly, underscoring the heterogeneous nature of AFM. With no standardized treatment protocol, clinicians must tailor management to each case. While steroids, IVIG, and plasmapheresis are commonly used, none have been proven more effective than the others. This uncertainty emphasizes the need for further research to establish evidence-based guidelines. A multidisciplinary approach involving healthcare providers, researchers, and families is critical for optimizing care and improving long-term outcomes. Future studies should focus on larger patient cohorts to better understand AFM’s clinical course and evaluate treatment efficacy.
Recommended Citation
Aldridge, Elizabeth M. and Samraj, Ravi, "The Various Clinical Presentations of Acute Flaccid Myelitis and Initial Treatment Responses" (2025). Research Symposium. 59.
https://scholarworks.utrgv.edu/somrs/2025/posters/59
The Various Clinical Presentations of Acute Flaccid Myelitis and Initial Treatment Responses
Background Acute Flaccid Myelitis (AFM) is a neurological disorder primarily affecting children, characterized by sudden muscle weakness or paralysis due to inflammation in the spinal cord's anterior horn cells. Often associated with viral infections, particularly enterovirus D68, AFM presents with variable symptoms and requires specific MRI findings for diagnosis. The CDC began tracking AFM in 2014, noting a biannual spike in cases during late summer, which aligns with an uptick in cases observed this past summer at our tertiary care children's hospital. In 2023, the U.S. reported 18 AFM cases, including three in Texas. Treatment options include intravenous immunoglobulin (IVIG), high-dose steroids, and plasmapheresis, although there is no definitive evidence supporting the superiority of any treatment. A recent study indicated that most patients experience some level of impairment 12 months post-diagnosis, highlighting the need for effective management and improved understanding of AFM’s long-term impact.
Summary of Cases
- Patient 1: A 3-year-old girl with no prior medical issues presented in late summer with left upper extremity weakness following a 5-day history of respiratory symptoms. MRI revealed signs consistent with AFM, and the patient tested positive for rhinovirus/enterovirus. She received high dose methylprednisone for five days and physical therapy. By discharge, her strength had improved significantly, with her left hand reaching 4/5 strength.
- Patient 2: A 2-year-old girl, admitted to the PICU in early fall with sudden onset paralysis, experienced rapid loss of movement in all four extremities. Despite normal MRI findings, her spinal cord MRI showed edema from the skull base to T4. She tested positive for multiple respiratory viruses. She was intubated for eight days and treated with steroids and IVIG. After two weeks, she showed gradual improvement in muscle function and was transferred to a rehabilitation facility.
- Patient 3: A 2-year-old girl presented in early fall with ascending paralysis, starting with fever and cough. She had difficulty with facial movements and minimal strength in her extremities. MRI of the spinal cord showed mild T2 hyperintensity from C2 to C7. She was intubated for respiratory support and treated with steroids and IVIG. Despite no significant improvement, she underwent plasmapheresis, which had to be stopped due to hypotension. She remained intubated, continuing physical and occupational therapy.
Conclusions This case series highlights the diverse clinical presentations and responses to treatment observed in AFM cases at a tertiary children’s hospital. The patients’ outcomes varied significantly, underscoring the heterogeneous nature of AFM. With no standardized treatment protocol, clinicians must tailor management to each case. While steroids, IVIG, and plasmapheresis are commonly used, none have been proven more effective than the others. This uncertainty emphasizes the need for further research to establish evidence-based guidelines. A multidisciplinary approach involving healthcare providers, researchers, and families is critical for optimizing care and improving long-term outcomes. Future studies should focus on larger patient cohorts to better understand AFM’s clinical course and evaluate treatment efficacy.
