A case of poliomyelitis-like syndrome

The authors report the case of a boy aged 4 years who had sudden abdominal pain and inability to walk on the day before admission to hospital and who developed abdominal distention and difficulty urinating. On admission, the abdominal skin reflexes, knee jerks, cremaster and anal reflexes were absent and power in the lower extremities was reduced. Spinal fluid examination showed a cell count of 383/mm3, with 95% neutrophils and 5% lymphocytes; spinal fluid protein of 44 mg/dl; and glucose 75 mg/dl. Serological studies did not reveal any significant antibodies for polio virus type 1, 2, 3, various ECHO viruses, Coxsackie types A4, A7, A9, B1 or B5. However, the titer of Coxsackie virus antibody type A10 was 128 in the acute phase and only 32 in the recovery phase 4 weeks later. Magnetic resonance scans were performed on the second day; the findings were normal in the brain, but interesting lesions were revealed in the thoracic cord with both T1-weighted images and T2-weighted images. Neurological symptoms improved asymmetrically.