Acute flaccid myelitis presumably caused by coxsackie virus A10

Enterovirus-D68 (EV-D68) has been presumed to be a major cause of acute flaccid myelitis (AFM) since its cluster in 2014.1 Coxsackie virus (CV)-A10 causes hand-foot-mouth disease, herpangina, and non-specific febrile illnesses, whereas neurological complications are rare. We encountered child with AFM during an outbreak EV-D68 infection autumn 2018 CV-A10 RNA was detected from her stool. The patient previously healthy 4-year-old girl. In September 2018, she developed fever cough. Five days later, right-dominant weakness noted both arms. She also had pain the neck. admitted our hospital 2 after onset weakness. On admission, manual muscle test (MMT) score 0–1 right shoulder elbow, 2–3 wrist, 4 left arm. No either leg. deep tendon reflexes were weak or absent arms, but maintained legs. cranial nerve functions normal no sensory disorders observed. Neurogenic bladder / bowel not seen. Laboratory testing revealed white blood cell count. Cerebral spinal fluid (CSF) analysis showed pleocytosis 227 cells/μL protein level 57 mg/dL. MRI 3 longitudinal high intensities spanning pons entire cervical spine (Fig. 1a). lower lesion uncertain because thoraco-lumbar evaluated. parenchymal anterior horn dominant 1b), involving gray matter. Head lesions medulla oblongata dorsal 1c,d). diagnosed treated intravenous immunoglobulin methylprednisolone pulse treatments beginning day admission. limb paralysis worsened treatment. Three could sit without support. 9 that less obvious 1e) contrast enhancement roots cauda equina 1f). subsequently improved, gradually. At months onset, MMT 5 hands, forearm, forearm Nerve transfer upper performed 6 discharge. 1 year discharge, scores arm improved 2–3. collected throat swab, urine, stool, blood, CSF specimens for detection, including enteroviruses, herpesviruses, adenoviruses. stool by PCR, any other specimens. Informed consent obtained patient's parents publication. This study approved institutional review board. Acute defined as acute-onset weakness, imaging showing cord grey matter suggestive myelitis.2 Cerebrospinal often reveals children AFM.1, Our all these features AFM. symptoms their time course similar those infection.1, interval between days. asymmetric disturbance neurogenic involvement. rapidly, reaching plateau within day. It is notable several viruses than can patients Ayers et al. reported stool/rectal swab 218 confirmed probable AFM.4 Suresh identified 30 5,450 paralysis.5 implies infrequently isolated form paralysis. Nevertheless, they stated related found case reports series. report will useful understanding clinical CV-A10. Regular virologic surveillance important identifying causative agents trends relation AFM, there possibility novel neurotropic enterovirus may emerge paralytic diseases. work supported Health Labor Sciences Research Grant Ministry Health, Welfare Japan (H28-Shinkogyosei-Ippan-007). authors declare conflict interest. F.B. A.O. contributed conception design this study. S.S. virological studies. F.B., M.H., S.M. data. drafted manuscript. critically reviewed manuscript supervised whole process. All read final