Acute flaccid paralysis in a neonate: tick bite a differential?

Tick paralysis is an uncommon, noninfectious, neurologic syndrome characterized by acute ataxia and ascending paralysis mostly seen in children. Early recognition and prompt management with tick removal helps in complete recovery. If untreated, ascending paralysis can lead to respiratory failure and death in 10% of the cases. Tick paralysis is usually considered as a differential in all cases of acute ataxia and generalized weakness in children and adults but seldom in neonates due to its rarity and differences in clinical presentation in the newborn period. In neonates, tick paralysis may present only as generalized weakness and lethargy with poor feeding. Even though tick paralysis is common in children <10 years of age, it has never been reported in a neonate. We report a case of tick bite paralysis in a baby who presented in the neonatal period, and identification of the tick and its removal that helped in rapid recovery.