Acute autonomic sensory and motor neuropathy associated with parvovirus B19 infection.
We report a 9-year-old girl with acute autonomic sensory and motor neuropathy (AASM) associated with human parvovirus B19 (HPV-B19) infection. The patient presented with fever, erythema of the entire body, and abdominal pain with vomiting. The titer of HPV-B19 IgM antibody was significantly elevated. Symptoms such as muscle weakness, severe hyperesthesia, dyshidrosis, and neurogenic bladder associated with autonomic disturbance developed over several days. Intravenous immunoglobulin therapy gave no obvious improvement of her symptoms. Motor and sensory impairment improved slowly without medical treatment, but dysautonomia persisted for a long time. Sural nerve biopsy revealed axonal degeneration of small fibers, involving both myelinated and unmyelinated fibers, which is compatible with the autonomic sensory and motor neuropathy. AASM is very rare in pediatric populations, and there is no report of AASM associated with HPV-B19 infection.
Hanai
Sae
S
Department of Child Neurology, National Center Hospital for Neurology and Psychiatry, National Center of Neurology and Psychiatry, Kodaira, Japan. hanai-s@ncchd.go.jp
Komaki
Hirofumi
H
Sakuma
Hiroshi
H
Nakagawa
Eiji
E
Sugai
Kenji
K
Sasaki
Masayuki
M
Oya
Yasushi
Y
Higurashi
Norimichi
N
Hamano
Shin-ichiro
S
D000914:Antibodies, Viral; D001342:Autonomic Nervous System Diseases / Q000209:etiology* / Q000821:virology; D002648:Child; D016731:Erythema Infectiosum / Q000150:complications*; D005260:Female; D006801:Humans; D046529:Microscopy, Electron, Transmission / Q000379:methods; D016732:Parvovirus B19, Human / Q000276:immunology / Q000472:pathogenicity*; D013497:Sural Nerve / Q000473:pathology / Q000648:ultrastructure
D000914:Antibodies, Viral