A pediatric case of Coxsackie A virus rhombencephalitis (1184)

• DOI: 10.1212/wnl.94.15_supplement.1184
• Publication Date: 2023-12-07T05:28:50Z
• Authors: Neel Fotedar; Kendall Wyllie; Peter Paul Lim; Bryony Jane Lucas; Megan Scruggs; Amy Edwards; Keith Ponitz; Jessica Goldstein

Objective: To report a case of infectious rhombencephalitis caused by Coxsackie A virus treated with Intravenous Immunoglobulin (IVIG). Background: Rhombencephalitis is rare neurologic condition that can be both bacterial and viral agents including Listeria monocytogenes, Enterovirus 71 A16. There no consensus treatment for this disease process but IVIG has been used in Taiwan Enteroviral favorable results. Earlier administration found to prevent progression pulmonary edema. Design/Methods: Chart Review Results: 2 year old African American male obstructive hydrocephalus status post endoscopic third ventriculostomy (ETV) 7 months prior presented fever, vomiting intermittent diarrhea concerning illness. On day 4 hospitalization, he developed perioral, truncal acral maculopapular erythematous rash followed new onset ataxia left beating horizontal torsional nystagmus which preceded rapid cardiopulmonary decline due septic shock. He was stabilized empirically broad spectrum antimicrobials until negative blood cerebrospinal fluid (CSF) cultures resulted. Brain MRI showed diffusion restriction the bilateral basal ganglia, pons middle cerebellar peduncles. Spine normal. CSF analysis lymphocytic pleocytosis normal protein glucose. Bacterial antigen panel enterovirus PCR were negative. Serology strongly positive virus. The diagnosis made. Patient received 2-day course without complications. improved from perspective within few days. At time discharge had persistent improving hemiparesis ataxia. Conclusions: Enteroviruses are commonly encountered pediatric populations, usually causing self-limited febrile illnesses such as gastroenteritis, rarely progressing significant neurological rhombencephalitis. Early may beneficial evolution collapse. Disclosure: Dr. Fotedar nothing disclose. Wyllie Lim Lucas Scruggs Edwards Ponitz Goldstein