Symptomtext
Term 4-mo female infant presented to ED 6/9/21 with 1 day history of motor weakness. ~ 2 weeks ago she had mild URI symptoms (cough) for only a couple of days and recovered to baseline. On 6/7 she received her 4-mo old vaccine series without acute side effects. She passed stool that day that was more smelly than usual with green tinge. The following day 6/8 AM she appeared generally well, several sneezes produced green mucous and her eye lids were slightly puffy. She was sent to daycare as usual. In the afternoon when dad picked her up she appeared ill with eye lids being puffy, poor head control. She only ate 2 out of 4 bottles during the day, 4 being her usual feeds while at daycare. When dad attempted to bottle her she had trouble latching on and milk was running out the corner of her mouth. Through out the evening she progressively became weaker with decreased limb movements. She presented to local ED overnight and was noted to have temp of 36.1F, RR 24 sating 99% on RA. She was noted to be lethargic and hypotonic. There was concern for sepsis/meningitis. She received 20 mL/kg IVF bolus. Her glucose was 89. She had a urinalysis which showed 1+ ketones but was otherwise reassuring. Her rapid influenza/SARS-CoV-2/RSV was negative. White blood cell count 8.2 (43% neutrophils, 47% lymphocytes), hematocrit 33.9, platelets 343. Sodium 138, potassium 4.2, chloride 105, bicarb 21, BUN 9, creatinine less than 0.2, AST 22, ALT 14. Lumbar puncture demonstrated WBC count of 4, RBC 4, glucose 57, protein 125. CSF Gram stain did not show any organisms. Sterile CSF culture. Chest x-ray was normal. The patient was noted to have an apneic event with an associated desaturation and was placed on 6 L HFNC. She was subsequently transferred to Hospital PICU for further evaluation and management. Upon arrival she continued to have worsening respiratory status necessitating intubation. Per parents there had been no fever, N/V/D. She feeds breast milk and formula, no solids, no honey, no soil/dirt exposure. There's no family history of neuromuscular disorder. Baby remains intubated on mechanical ventilation in PICU
Weitere VAERSDATA-Felder
- Praegender Schweregrund
- Intensive care
- Hospital-Tage
- 13,0
- Labordaten
- Stool test negative for botulism. Anti GQ1B Ab negative. MEDICATIONS: 1. S/p BabyBIG 6/10 2. S/p IVIG 2g/kg 6/11-6/15 Rapidly progressive motor weakness with respiratory failure as the admitting Dx, parents report more movements in the past 48 hours. Compared to physical exam one week ago, there has been small but demonstrable improvement in motor function, now with some limited spontaneous movements. Although previous clinical history and course appeared most consistent with infantile botulism, no clear exposure ever identified and now stool study negative. Although age of presentation and descending paralysis less typical for demyelinating process such as Guillain-Barr? syndrome, the cytoalbumin disassociation on CSF studies and nerve root enhancement more consistent with this process. Anti-GQ 1B antibody which is positive in a subset of Miller Fisher variant Guillain-Barr? syndrome and other similar demyelinating conditions with cranial nerve involvement was also negative, but certainly does not rule out Guillain-Barr? syndrome as potential etiology of her weakness. I am very pleased that she has started to show some, albeit modest, recovery of motor movement. Given negative stool study for botulism, would recommend repeat imaging of MRI brain with and without contrast with dedicated cuts through the IACs and brainstem, as well as MRI of total spine to assess for any evolution in prior findings. Would also revisit the option of obtaining EMG and nerve conduction studies. Continue supportive care. Neurology will continue to follow.
- Aktuelle Erkrankungen
- Gastroesophageal reflux disease (GERD) of infancy
- Vorgeschichte
- 3-day hospitalization at 7-mo old (3/28-31, 2021) for BRUE secondary to choking episode with breastmilk. Chronic history of GERD and choking episodes with breastfeeding since 2 weeks of age. Echocardiogram 3/29/21 revealed PFO with left-to-right shunting and mild pulmonary valve stenosis, followed by Pediatric Cardiology
- Andere Medikamente
- Famotidine for gastroesophageal reflux of infancy
- Allergien
- Antibiotic CEFTRIAXONE (non-urticarial rash involving face, chest and groin during first IV Ceftriaxone infusion)
- Vorherige Impfungen
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