A pediatric patient of hemorrhagic acute transverse myelitis.
An 11-year-old boy presented with progressive leg hypesthesia but no history of trauma. Dysuria and constipation appeared subsequent to gait difficulty. He was admitted 8days after onset. Spinal magnetic resonance imaging (MRI) revealed longitudinal hyperintensity with cord swelling and hypointensity on T2-weighted images, suggesting severe inflammation and microbleeding change, respectively. Gadolinium contrast-enhanced MRI demonstrated mild enhancement in the lesions. Platelet count and coagulation findings were normal, and cerebrospinal fluid analysis showed no pleocytosis. He was diagnosed with idiopathic acute transverse myelitis (ATM), and intravenous methylprednisolone pulse therapy and plasmapheresis were initiated. On day 14, motor dysfunction aggravated suddenly, accompanied by expanding hemorrhagic lesions. Thereafter, administration of intravenous immunoglobulin, repeated intravenous methylprednisolone pulse therapy and prednisolone for one month resulted in complete recovery four months later. Both anti-aquaporin-4 and anti-myelin oligodendrocyte glycoprotein antibodies were negative. We presented the first pediatric case showing hemorrhagic spinal lesions in the clinical course of ATM. This severe complication should be recognized in the management of ATM.
Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan.
Masataka
M
Fukuoka
Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan. Electronic address: i-kuki@med.osakacity-hp.or.jp.
Ichiro
I
Kuki
Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan.
Hisashi
H
Kawawaki
Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan.
Kiyohiro
K
Kim
Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan.
Yuka
Y
Hattori
Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan.
Hitomi
H
Tsuji
Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan.
Asako
A
Horino
Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan.
Megumi
M
Nukui
Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan.
Shin
S
Okazaki
D051401:Aquaporin 4 / Q000276:immunology; D002648:Child; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D009188:Myelitis, Transverse / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology*; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D013116:Spinal Cord / Q000473:pathology*; D016896:Treatment Outcome
C496030:AQP4 protein, human; D051401:Aquaporin 4; D016756:Immunoglobulins, Intravenous; D011239:Prednisolone; D008775:Methylprednisolone
Children; Myelitis; Plasmapheresis; Spinal hemorrhage; Treatment