Asymptomatic viral gastrointestinal infection: the missing link?
Tyler Robert Peikes1, Juan Pablo Appendino
1University of Manitoba Faculty of Medicine, Section of Genetics and Metabolism, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada;
Insights
Benign infantile seizures associated with mild gastroenteritis (BISMG) can manifest solely as seizures, even without gastrointestinal symptoms. This condition may present as apparent life-threatening events in infants.
Area of Science:
- Pediatrics
- Neurology
- Infectious Disease
Background:
- Infantile seizures can present with varied etiologies.
- Apparent life-threatening events (ALTEs) require thorough investigation.
- Benign infantile seizures associated with mild gastroenteritis (BISMG) is a recognized, though less common, cause of seizures.
Observation:
- An 8-month-old boy experienced recurrent apneic episodes and seizures.
- Standard investigations including EEG and MRI were unremarkable.
- Stool virology identified a small round virus, leading to a diagnosis of BISMG despite absent GI symptoms.
Findings:
- The patient's seizures resolved after phenobarbital administration.
- The clinical presentation mimicked typical BISMG, suggesting a viral etiology.
- Atypical presentation of BISMG without gastrointestinal symptoms was observed.
Implications:
- BISMG may present solely with seizures, without overt gastrointestinal manifestations.
- BISMG should be considered in the differential diagnosis of ALTEs in infants.
- This case highlights the importance of considering viral gastroenteritis as a cause of neurological symptoms in infants.
Abstract:
We present the case of an 8-month-old boy who presented with apparent life-threatening events later characterized as seizures in clusters. A total of 14 apneic episodes were observed within 24 hours before loading the patient with phenobarbital at which point the seizures stopped. There was no obvious explanation for his seizures. EEG revealed midline interictal discharges; MRI-head was normal; and all other investigations were normal. The patient's stool was sent for virology with the clinical suspicion of benign infantile seizures associated with mild gastroenteritis (BISMG) despite lack of gastrointestinal symptoms. A small round virus was found. His clinical course followed the same progression as typical BISMG. This begs the question whether it is possible for virus in the stool to cause an asymptomatic gastrointestinal infection with its only clinical manifestation as seizures. We conclude that it may be possible for BISMG to present without gastrointestinal symptoms. As well, BISMG may be an unrecognized cause of apparent life-threatening events and should be considered in the differential diagnosis.
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