A Case of Acute Transverse Myelitis Following Enteroviral Meningitis

Abstract

Acute transverse myelitis is a rare acquired inflammatory disease of the spinal cord that presents with rapid onset of bilateral motor weakness, sensory alterations, and bladder or bowel dysfunction. Enetroviruses are the most common pathogens of aseptic meningitis, which is usually self-limited and recovers completely without complication. However, enteroviruses can also cause more severe neurological diseases such as encephalitis, Guillain-Barre syndrome, and myelopathy. A 6-year-old girl was admitted to our hospital because of weakness in both lower extremities, sensory alterations below the umbilicus, and bladder and bowel dysfunction. One day prior to admission, the patient experienced a fever, headache, and recurrent vomiting, and was diagnosed with enteroviral meningitis at our emergency department. Cerebrospinal fluid and stool samples collected from the patient revealed enterovirus-positivity via reverse transcription polymerase chain reaction. Magnetic resonance imaging revealed high signal intensity in the spinal cord at the level of C2-C7 and T3-T11 on sagittal T2-weighted images. Despite intravenous immunoglobulin, high-dose methylprednisolone, and physical therapy, the patient was still unable to walk and required intermittent nelaton catheterization for urination at 11 months after the disease onset. This report demonstrates that enteroviral meningitis, which is known to be a relatively benign condition, can progress to critical neurological disease such as acute transverse myelitis.