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2023

ANUÁRIO DO HOSPITAL
DONA ESTEFÂNIA

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GAIT UNSTEADINESS AND PARAESTHESIA IN A 12-YEAR-OLD: A RARE COMPLICATION OF INFECTIOUS MONONUCLEOSIS

Maria Soto-Maior Costa1; José Pedro Vieira2; Maria João Brito1

1 - Unidade de Infecciologia Pediátrica, Área da Pediatria, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
2 - Neuropediatria, Área da Pediatria, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa

38th Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID) - Virtual Meeting. 26 a 29 de outubro de 2020. Poster

Resumo:
Background: Infectious mononucleosis is a common clinical syndrome in paediatric age, particularly in adolescence, caused by the Epstein-Barr virus. Guillain-Barré syndrome (GBS) is a term encompassing the several variants of acute immune-mediated polyneuropathies. Typically, there is history of an antecedent infection, thought to trigger the immune response that leads to peripheral nerve damage. GBS following infectious mononucleosis has been rarely reported.
Case Presentation Summary: A 12-year-old girl presented with bilateral paraesthesia in her toes, associated with calf and plantar pain, resulting in trouble to walk. She had been diagnosed with infectious mononucleosis 2 weeks earlier. Neurological exam revealed only mild gait unsteadiness. Electromyography (EMG) was normal. Cerebrospinal fluid revealed pleocytosis 34/μL and proteins 148.8mg/dL. She started empiric ceftriaxone and acyclovir, as well as intravenous immunoglobulin (IVIG) 400mg/day for 5 days. A couple days later, it was difficult to elicit lower limbs deep tendon reflexes and was evident a mild paresis of the right lower limb (score 4-/5 on foot and hallux plantar flexion and dorsiflexion; score 4/5 on leg flexion and extension). Spinal MRI revealed signal enhancement after gadolinium on some roots of cauda equina. She repeated EMG, revealing a motor demyelinating pattern consistent with GBS. PCR for Epstein-Barr virus was positive in cerebrospinal fluid. The remaining laboratory work was negative, including antiganglioside antibodies. The sensory symptoms improved completely until patient discharge.
Learning Points/Discussion: GBS in paediatric patients can present with subtle clinical manifestations early in its course; moreover, all supportive features in diagnostic testing may not be present at first, making the clinical suspicion the key to adequate diagnosis. Some data suggest that IVIG shortens the time to recovery compared with supportive care alone, but large randomized controlled trials are needed to support this data.

Palavras Chave: mononucleose infeciosa; síndrome Guillain-Barré; vírus Epstein-Barr