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Critical illness polyneuromyopathy in a child with severe demyelinating myelitis

Tanja Adamovic1, Ariane Willems, Michel Vanasse

  • 1Division of Pediatric Critical Care, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada.

Journal of Child Neurology
|March 7, 2009
PubMed

Insights

This case report details an infant with demyelinating myelitis who developed critical illness polyneuropathy after corticosteroid treatment. The condition led to severe weakness and respiratory failure, ultimately proving fatal.

Area of Science:

  • Pediatric Neurology
  • Neuromuscular Disorders

Background:

  • Acute demyelinating myelitis can present with severe neurological deficits in infants.
  • Critical illness polyneuropathy and myopathy are serious complications in critically ill patients.

Observation:

  • An 8-month-old boy with acute demyelinating myelitis developed limb weakness and respiratory failure.
  • Initial treatment with corticosteroids was administered due to suspected spinal cord trauma.
  • Electromyography and nerve conduction studies suggested Guillain-Barré syndrome, but treatment was ineffective.

Findings:

  • Muscle biopsy revealed severe critical illness myopathy, while nerve biopsy showed mild neuropathy.
  • The patient experienced no improvement and succumbed after 5 months.
  • This suggests critical illness polyneuromyopathy may occur secondary to corticosteroid use in acute demyelinating myelitis.

Implications:

  • Corticosteroid therapy in acute demyelinating myelitis may precipitate critical illness polyneuromyopathy in infants.
  • This case underscores the need for careful monitoring and consideration of alternative treatments.
  • Further research is needed to elucidate the mechanisms and optimal management strategies.

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