My area has recently seen 3 children at 2 separate facilities present with eerily similar and so far undiagnosed problems. Similar age group, but nothing else in common (different locations, ethnicities, no similar contacts or travels, etc.)
Presentation: 2-3 day history of fever, c/o headache, occasional vomiting. ER admission due to changes in level of consciousness or physical mobility.
Work-up: CT, MRI, LP, pan-cultures, viral panel of CSF, blood and secretions, standard lab work-up. All repeated after a few days of admission. Regular blood cultures. All results unremarkable. WBC's normal, CRP mildly elevated in 1-2 patients, CT and MRI normal, spinal fluid clear, cell count, protein, glucose results normal. All cultures and panels persistently negative.
Treatment: Broad-spectrum antibiotics and antivirals including max doses of vancomycin, ampicillin and acyclovir.
Course of stay: Progressive decline in neurological status. Most recent presenting patient deteriorated from oriented and physically appropriate to a GSC score of 6 within 8 hours. Seizures in the first 2 presenting patients. Loss of ability to maintain airway. Intubated for currently 2 weeks and 4 weeks respectively.
We are all at a loss. Does anyone have any insight?
Found this article, as I was researching what one of our contributors had posted. This is about Dr. Dalmou and his discovery of the anti-NMDA encephalitis. Pertinent to me also as a high percentage of sufferers had tumors and it is sometimes considered a paraneoplastic disorder.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Have they thought about Parvo 19 (fifth's disease) encephalitis...rare but present the same. You didn't mentions rash.....but the rash may not be visible.....
I'm hoping these kids recover so PLEASE do not take my next comment the wrong way, but I enjoy the mental / clinical challenge of cases like this. They really stretch you as a nurse, and seem to draw things out of your memory banks that you hadn't thought of in years.
Thank you all for your insight. I'm definitely going to bring up several of these suggestions on my next shift.
No real update yet. The third patient to present was intubated only a few days after admission, following the pattern of the previous patients. IVIG has been initiated on at least two of the patients that I know of with no change in clinical status. We've also learned of a fourth child with the same symptoms at a hospital about 20 miles away.
Of possible significance is that all patients so far have been male between the ages of 10 and 13.
Specializes in NICU, PICU, PCVICU and peds oncology.
Reye's syndrome would show up in the labs... abnormal liver enzymes. As marycarney says, the demographic is another pice of the puzzle. I'm assuming these kids have all had tox screens done as part of their admission work-ups. Very curious.
First thing that came to mind was Guillain Barre Syndrome but you said no ascending paralysis. Agree with those who said encephalitis especially the anti-NMDA receptor encephalitis and/or herpes viral encephalitis. Another thought - you said these were all boys, ages 10-13 living within 10 miles of eachother. Could they go to the same school? That's about middle school age. Maybe something in the cafeteria? Lead poisoning? Some cross contamination with anti-pest substances (rat poison, etc.)?
Specializes in LTC, CPR instructor, First aid instructor..
A lot of mysterious diseases are popping up from over use of antibiotics. This is a photo of my niece. She has had cancer twice, (notice her arm) This is from the removal of a cancerous tumor located in her arm pit. Her throat is still very sore, and she has had numorous tumors removed from her body. None of us know where this disease came from. My brother and sister-in-law were both genetically tested and were negative for the neurofiborblastosis that ravages her body. She just turned 16.
Momof2inMO
21 Posts
Found this article, as I was researching what one of our contributors had posted. This is about Dr. Dalmou and his discovery of the anti-NMDA encephalitis. Pertinent to me also as a high percentage of sufferers had tumors and it is sometimes considered a paraneoplastic disorder.
http://www.aan.com/elibrary/neurologytoday/?event=home.showArticle&id=ovid.com:/bib/ovftdb/00132985-200805150-00012
And some basic info from Wiki, http://en.wikipedia.org/wiki/Anti-NMDA_receptor_encephalitis
Whatever it is, glad you are working so hard to figure it out.