A Six-year Old Girl with Acute Severe Flaccid Paralysis and Enterovirus
D68 Infection- a case-report from the European continent implying a
worldwide spread?
M.D., Ph.D. Helle Cecilie Viekilde Pfeiffer1, LIS, M.D. Marius K Skram1, M.D. Hilde Dahl1, M.D.
Per-Kristian Knudsen1, M.D. Maninder S Chawla2, MSc, Ph.D. Mona Holberg-Petersen3, M.D., Ph.D.
Karoline Bragstad4, M.D., Ph.D. Susanne G Dudman4, M.D., Ph.D. Anne-Marte B Kran3, *M.D.
Astrid E Rojahn1
1
Department of Pediatrics, Oslo University Hospital, P. O. Box 4950 Nydalen, N-0424 Oslo, Norway
Department of Radiology, Oslo University Hospital, P. O. Box 4950 Nydalen, N-0424 Oslo, Norway
3
Department of Virology, Norwegian Institute of Public Health, Lovisenberggata 8, 0456 Oslo,
Norway
4
Department of Microbiology, Oslo University Hospital, University of Oslo, Institute of Clinical
Medicine, Oslo, Norway
2
*Corresponding Author: Astrid E. Rojahn, Department of pediatrics, Pediatric Infectious Disease Unit,
Oslo University Hospital, P. O. Box 4950 Nydalen, N-0424 Oslo, Norway, E-mail: asro@uus.no
Abstract:
We report a case of severe Acute Flaccid Paralysis associated with enterovirus D68 in a sixyear old girl from Norway. She was admitted on September 20, 2014, with a poor general
condition, complaints of neck pain, upper airway symptoms, abdominal pain, vomiting, and
later increasing muscular weakness. Respiratory failure due to muscle weakness led to
intubation two days later and an MRI-scan revealed oedema of the brain stem and cordal grey
matter, extending from upper brainstem to the thoracolumbar level.
Enterovirus-D68 was identified in the nasopharyngeal specimen. After 2 months she has
recovered slightly but still has severe neurological symptoms. The patient cannot stand or sit
unsupported, and head control is poor. Motor impairment is worse proximally and more
pronounced in upper extremities and neck. She relies on nasogastric tube-feeding, and has
poor swallowing function. CPAP on a tracheal tube can be paused shortly. She started
speaking this week.
Enterovirus D68 is increasingly associated to Acute Flaccid Paralysis, mainly in children, and
most cases are from USA and Canada. This is to our knowledge the second reported case
from Europe. Both became sick in September 2014. Awareness toward this possible
neurological complication of enterovirus D68 infection is needed.