Acute Motor Axonal Polyneuropathy in a Child with Mumps
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SCIENTIFIC LETTER
Acute Motor Axonal Polyneuropathy in a Child with Mumps Namita Ravikumar 1 & C. R. Vishwa 1 & Pradip Paria 2 & Suresh Kumar Angurana 1 Received: 28 May 2020 / Accepted: 30 July 2020 # Dr. K C Chaudhuri Foundation 2020
To the Editor: A 7-y-old female presented bilateral cheek swelling, fever, vomiting, and headache for 7 d; and pain and weakness of lower limbs followed by upper limbs; and difficulty in swallowing and speaking and drooling of saliva for last 2 d. Examination revealed an alert and anxious child with pulse rate 72/min, respiratory rate 26/min, and blood pressure 114/68 mmHg; bilateral tender swelling in parotid region, weak gag reflex, hypotonia of all 4 limbs, power of 3/5 in upper and 2/5 in lower limbs, absent deep tendon reflexes, mute plantar reflexes; and no sensory and cerebellar signs, cranial nerve palsy, and signs of meningeal irritation. Cerebrospinal fluid examination (CSF) revealed 72 mononuclear cells/mm3, sugar 58 mg/dl, and protein of 120 mg/dl. Nerve conduction study (NCS) revealed acute motor axonal polyneuropathy. Serum IgM ELISA for mumps was positive. By day 2 of admission, she developed respiratory weakness for which she was started on invasive mechanical ventilation. She received intravenous immunoglobulin (IVIG) (2 g/kg over 2 d). As there was gradual improvement in muscle power, she was weaned from mechanical ventilation and extubated on day 11 and discharged on day 18 of admission with power of 4/5 in upper and lower limbs (able to walk with support). At 2 mo follow-up, she attained normal ambulation. Mumps is a common vaccine-preventable disease caused by Mumps virus which is a RNA virus belongs to the Paramyxoviridae family. There has been a resurgence with more severe manifestations in adolescents and adults possibly due to waning immunity and diminished vaccine efficacy [1]. The common clinical manifestations include fever, malaise, parotitis (95%), asymptomatic pleocytosis (40–60%), orchitis * Suresh Kumar Angurana [email protected] 1
2
Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India Division of Pediatric Neurology, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
(20%), pancreatitis (5%), meningitis (5–15%), meningoencephalitis (0.1–0.5%), transverse myelitis, facial palsy, sensorineural hearing loss (4%), and aqueductal stenosis [1, 2]. The acute motor axonal polyneuropathy associated with mumps infection is seldom reported [2–5]. The pathogenesis may be due to direct viral involvement or molecular mimicry [2–4]. The rapid recovery seen in index case may suggest a less severe form of axonal neuropathy caused by mumps compared with other causative agents like Campylobacter jejuni, which usually take a longer time to recover [3, 4]. The clinical and laboratory findings in the index child were consistent with mumps parotit
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