scholarly journals Secondary Scoliosis as a Complication of Acute Transverse Myelitis in a Child

2020 ◽  
Vol 5 (2) ◽  
pp. 39
Author(s):  
Silvia D’Amico ◽  
Piero Pavone ◽  
Gianluca Testa ◽  
Filippo Greco ◽  
Lidia Marino ◽  
...  
Keyword(s):  
Transverse Myelitis ◽  
Complete Recovery ◽  
High Dose ◽  
Drug Induced ◽  
Rehabilitative Treatment ◽  
Immunomodulating Therapy ◽  
Acute Transverse Myelitis ◽  
Appropriate Treatment ◽  
Autoimmune Conditions ◽  
Thoracolumbar Curve

Acute transverse myelitis (ATM) is a rare neurological condition that affects the spinal cord. Several events, including infections, autoimmune conditions, inflammatory, and drug-induced factors, may cause this disorder. Correct and rapid etiological diagnosis is necessary in order to start appropriate treatment that mainly consists of immunomodulating therapy, high dose intravenous corticosteroids, and in plasma exchange in noninfectious cases. The outcome is varied and depends on several factors. In children, the prognosis is usually good. We report a case of an 11-year-old boy who presented with interscapular pain, right leg steppage, homolateral hyposthenia of the upper limb, and signs of autonomic dysfunction. After performing specific and instrumental exams, a diagnosis of transverse myelitis was reached, and appropriate therapy was performed. A few days post-treatment, the child developed a secondary scoliosis, involving a thoracolumbar curve with loss of cervical and lumbar lordosis. After rehabilitative treatment was undertaken for 12 months, a complete recovery and normal restoration of spinal physiological curves was obtained. The pediatric cases of ATM have a good response to steroid therapy combined with physiotherapy. Collaboration among the various specialists is worthwhile, in order to lead to a correct and rapid diagnosis.

Pediatric Acute Transverse Myelitis Overview and Differential Diagnosis

2012 ◽  
Vol 27 (11) ◽  
pp. 1426-1436 ◽  
Author(s):  
Varina L. Wolf ◽  
Pamela J. Lupo ◽  
Timothy E. Lotze
Keyword(s):  
Differential Diagnosis ◽  
Pediatric Population ◽  
Correct Diagnosis ◽  
Transverse Myelitis ◽  
Acute Onset ◽  
Clinical Syndrome ◽  
Demyelinating Diseases ◽  
High Dose ◽  
Immunomodulating Therapy ◽  
Acute Transverse Myelitis

Acute transverse myelitis is a clinical syndrome affecting the spinal cord, which is characterized by acute onset of motor, sensory, and autonomic dysfunction. Approximately 20% of cases of acute transverse myelitis occur in children. This review summarizes the current published literature on acute transverse myelitis, including epidemiology, diagnostic criteria, pathogenesis, clinical presentation, clinical evaluation, and differential diagnosis. The article also summarizes the neuroimaging features, acute and chronic complications, treatments, and prognosis of acute transverse myelitis in the pediatric population. The initial evaluation centers on differentiation from other causes of myelopathy, and cases are further divided into idiopathic or disease-associated acute transverse myelitis. Correct diagnosis is important for treatment and prognosis. Treatment begins with intensive surveillance for acute life-threatening respiratory or autonomic complications. Immunomodulating therapy is recommended for noninfectious causes, using high-dose intravenous corticosteroids or plasma exchange. Other therapeutic options are also discussed. Prognosis depends on a number of factors, and evidence suggests that the majority of children have a good outcome. A small percentage of children diagnosed with acute transverse myelitis later are diagnosed with other demyelinating diseases, especially neuromyelitis optica, or multiple sclerosis. The most common long-term complications of acute transverse myelitis are urinary, motor, or sensory dysfunction.

Case of neuromyelitis optica: bilateral sensorineural hearing loss and transverse myelopathy following intrathecal chemotherapy

2020 ◽  
Vol 13 (4) ◽  
pp. e234076 ◽  
Author(s):  
Sergio A Castillo-Torres ◽  
Carlos A Soto-Rincón ◽  
Héctor J Villarreal-Montemayor ◽  
Beatriz Chávez-Luévanos
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Transverse Myelitis ◽  
Intrathecal Chemotherapy ◽  
Sensorineural Hearing ◽  
Intrathecal Methotrexate ◽  
High Dose ◽  
Chemotherapeutic Drugs ◽  
Acute Transverse Myelitis ◽  
Bilateral Sensorineural Hearing Loss

Neurotoxicity from intrathecally administered chemotherapeutic drugs is frequent, particularly with some agents like methotrexate, which are more prone to developing adverse effects. Myelopathy ranks among the most frequently reported neurological entities; with the diagnosis being straightforward, after ruling out infectious, metabolic, autoimmune or paraneoplastic causes. Scarcity of cases precludes evidence-based recommendations for the management of these complications. The most common therapeutic approach consists of the suspension of chemotherapy, exclusion of infectious and neoplastic causes, with prompt administration of high-dose steroids. We report a 21-year-old patient with acute lymphoblastic leukaemia, who developed acute transverse myelitis and bilateral sensorineural hearing loss, after five rounds of intrathecal methotrexate and cytarabine. Although neurotoxicity from both agents has been documented, this combination has not been previously reported.

scholarly journals Conus myelitis associated with Covid 19 infection – a rare complication

2022 ◽  
pp. 259
Author(s):  
Keyword(s):  
Rare Complication ◽  
Neurological Complication ◽  
Transverse Myelitis ◽  
Respiratory Illness ◽  
Conus Medullaris ◽  
Nasopharyngeal Swab ◽  
High Dose ◽  
High Grade Fever ◽  
Acute Transverse Myelitis ◽  
Pulmonary Manifestations

Covid 19 pandemic has taken away millions of lives. Our understanding of this disease, till to date, is not complete. This disease has a wide variety of neurological manifestations. Acute transverse myelitis is one such rare neurological complication of Covid 19. The exact etiology is not clear. Auto immunity might be one of the possible mechanisms. We report a case of 39-year-old lady, who had recent history of high-grade fever and cough. This was followed by weakness of both legs and in- ability to pass urine. SARS-CoV-2 (PCR) from nasopharyngeal swab was positive. She was found to have features of acute non compressive myelopathy. MRI brain and MRI cervical spine with contrast was normal. MRI dorso lumbar spine with contrast was suggestive of diffuse hyper intensity of conus medullaris with contrast enhancement suggestive of conus myelitis. CSF analysis ruled out infection and autoimmune causes. She was pulsed with high dose steroids. There was some transient improvement in symptoms. Learning points: 1) Physicians should not consider Covid as a respiratory illness only. It can present with a variety of extra pulmonary manifestations. 2) Acute transverse myelitis is a rare complication of Covid 19 infection. Timely recognition and treatment can prevent permanent neurological damage and residual disability. 3) Conus myelitis might not present with classic upper motor neuron signs. Any new onset bladder dysfunction in a setting of a recent covid infection should be taken seriously and requires urgent imaging of the spine.

High-dose methotrexate-induced reversible grade 4 hyperbilirubinaemia and transaminitis in an adolescent with Burkitt Leukaemia

2021 ◽  
Vol 14 (1) ◽  
pp. e237512
Author(s):  
Sanjeev Khera ◽  
Randhir Ranjan ◽  
Sateesh Ramachandran ◽  
Ajay Beriwal
Keyword(s):  
Liver Injury ◽  
Clinical Significance ◽  
Short Latency ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Drug Induced ◽  
Common Cause ◽  
Drug Induced Liver Injury ◽  
Dose Methotrexate

Symptomatic drug-induced liver injury (DILI) is an uncommon problem. Direct DILI is dose-related, predictable with short latency (hour to days) and is generally associated with transient and reversible transaminitis without jaundice. Antimetabolites including methotrexate are a common cause for direct DILI. Hepatotoxicity associated with high-dose methotrexate (HD-MTX) is generally transient and includes reversible elevation of transaminase in up to 60% and associated hyperbilirubinaemia (≤grade 2) in 25% of courses and therefore is of no clinical significance. Severe grades of DILI with HD-MTX (grade ≥4) are extremely rare. We describe an adolescent with Burkitt leukaemia who had reversible grade 4 DILI including hyperbilirubinaemia postfirst course of HD-MTX. Rechallenge with two-third dose of HD-MTX in subsequent chemotherapeutic cycle did not cause recurrence of DILI.

scholarly journals A possible interaction between favipiravir and methotrexate: Drug-induced hepatotoxicity in a patient with osteosarcoma

2021 ◽  
pp. 107815522110313
Author(s):  
Emre Demir ◽  
Osman Sütcüoğlu ◽  
Beril Demir ◽  
Oktay Ünsal ◽  
Ozan Yazıcı
Keyword(s):  
Drug Interactions ◽  
Toxic Hepatitis ◽  
Antiviral Agents ◽  
Antiviral Agent ◽  
Aldehyde Oxidase ◽  
Chemotherapeutic Agents ◽  
High Dose ◽  
Drug Induced ◽  
Metastatic Osteosarcoma ◽  
Grade 3

Introduction Favipiravir is an antiviral agent that is recently used for SARS-CoV2 infection. The drug-drug interactions of favipiravir especially with chemotherapeutic agents in a patient with malignancy are not well known. Case report The patient diagnosed with metastatic osteosarcoma was given high dose methotrexate treatment, and favipiravir was started on the third day of the treatment with suspicion of SARS-CoV2 infection. Grade 3 hepatotoxicity developed after favipiravir. Management & outcome: The acute viral hepatitis panel and autoimmune liver disease panel were negative. The ultrasound of the abdomen was unremarkable for any hepatobiliary pathology. The all viral and hepatobiliary possible etiological factors were ruled out. The patient’s liver enzymes increased just after (12 hours later) the initiation of favipiravir, and we diagnosed toxic hepatitis caused by favipiravir-methotrexate interaction. Therefore, methylprednisolone 1 mg/kg dose was started for a presumed diagnosis of toxic hepatitis. Hepatotoxicity completely regressed after favipiravir was discontinued. Discussion Favipiravir may inhibit methotrexate elimination by inhibiting aldehyde oxidase and its sequential use may cause hepatotoxicity in this case. The clinicians should keep in mind possible drug interactions while using new antiviral agents against SARS-CoV2 like favipiravir.

scholarly journals Acute transverse myelitis after SARS-CoV-2 infection: a rare complicated case of rapid onset paraplegia

2021 ◽  
Author(s):  
Hamze Shahali ◽  
Ali Ghasemi ◽  
Ramin Hamidi Farahani ◽  
Amir Nezami Asl ◽  
Ebrahim Hazrati
Keyword(s):  
Transverse Myelitis ◽  
Rapid Onset ◽  
Complicated Case ◽  
Acute Transverse Myelitis

scholarly journals Prognostic factors for relapse and outcome in pediatric acute transverse myelitis

2021 ◽  
Author(s):  
Jelte Helfferich ◽  
Arlette L. Bruijstens ◽  
Yu Yi M. Wong ◽  
E. Danielle van Pelt ◽  
Maartje Boon ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Transverse Myelitis ◽  
Acute Transverse Myelitis
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