title: Acute abdominal pain as the only symptom of a thoracic demyelinating lesion in multiple sclerosis.
abstract: Multiple sclerosis (MS) is a syndrome characterized by complex neurological symptoms resulting from demyelinating lesions in the central nervous system. We report a child with a relapse of MS whose only presenting symptom was severe abdominal pain. Dysfunctional intestinal mobility was assessed by abdominal computed tomography. Findings resembled paralytic ileus resulting from peritonitis. However, the patient demonstrated no other symptoms of peritonitis. A T2-weighted magnetic resonance image revealed a new demyelinating lesion localized to thoracic segments T4-T12. The lesion presumably affected autonomic efferents involved in intestinal mobility. Treatment with a pulse of methylprednisolone reduced both abdominal pain and lesion size. To our knowledge, this is the first reported case of a pediatric MS patient with a demyelinating lesion associated with an autonomic symptom of altered intestinal mobility in the absence of neurological symptoms. This atypical presentation of MS highlights the need for physicians' vigilance when treating this patient population.
authors: Department of Pediatrics, Osaka Medical College, Takatsuki, Osaka, Japan. Electronic address: nomusyo@gmail.com.
authors: Shohei
authors: S
authors: Nomura
authors: Department of Pediatrics, Osaka Medical College, Takatsuki, Osaka, Japan.
authors: Shuichi
authors: S
authors: Shimakawa
authors: Department of Pediatric Neurology, Hirakata Municipal Hospital, Hirakata, Osaka, Japan.
authors: Mitsuru
authors: M
authors: Kashiwagi
authors: Department of Pediatric Neurology, Tanabe Children's Clinic, Hirakata, Osaka, Japan.
authors: Takuya
authors: T
authors: Tanabe
authors: Department of Pediatrics, Osaka Medical College, Takatsuki, Osaka, Japan.
authors: Miho
authors: M
authors: Fukui
authors: Department of Pediatrics, Osaka Medical College, Takatsuki, Osaka, Japan.
authors: Hiroshi
authors: H
authors: Tamai
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D002648:Child; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D012008:Recurrence; D013116:Spinal Cord / Q000473:pathology; D035423:Thoracic Cavity; D015898:Tomography Scanners, X-Ray Computed
keywords: Abdominal pain; Multiple sclerosis; Paralytic ileus; Thoracic spinal lesion