What is wrong with these kids? (Mystery Diagnosis) - page 4
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,... Read More
Apr 7, '13Quote from Ashley, PICU RNNo PMH. All of these patients were healthy previous to their admission. Immunizations UTD on most, with no recent vaccinations in the past 6 months. CSF and blood was sent for a viral panel- I'm not sure if West Nile is included in these results but last time I checked the full results of the viral panel were still pending for the one patient left on our unit (the other was transferred at the request of the understandably frustrated parents searching for answers).
The operating assumption is unspecified viral encephalitis. And actually, the patient on our unit is improving slowly and was actually extubated recently. The other three, to my knowledge, remain intubated. I suppose it's possible that we may never know exactly what caused this, which would be a rather anti-climactic end to this thread.
Because of the similar symptoms, it seems like their has to be something in common, but so far nothing has been noted. Different locations, different schools, never met before, no similar contacts that we know about, no school trips, and we live in a fairly urban area so there is limited contact with exotic animals. Pets are an option, but in four separate households it just seems strange. Something environment you'd expect a more wide-spread outbreak.
I'm in NJ and I'd rather not specify any more than that. To my knowledge the CDC is not involved yet, although there has been talk of bringing it to their attention.
I have ready over this many times, and I am always happy to see updates. It has become about of a diagnostic challenge for me and I oft consider what my impression would be if I was the provider (though I haven't seen kids in a while).
Viral encephalitis would have been my primary working dx, given the presentations.
I would consider the zebras:
Murine typhus, ADEM, RMSF, Q fever.
Apr 7, '13It's also possible that these cases are unrelated and any similarities are coincidental.
I found this helpful article on viral encephalitis.
Viral encephalitis - New York Methodist Hospital
Apr 8, '13I am just a state away and our region tends to have the earliest West Nile cases every year, it seems.
Q-fever - one of my favorite zebras...as an aside.
Apr 17, '13We have seen multiple pts with teratomas, resulting in severe neuro symptoms from constant movement, to seizures. The ages varied from toddler to teenagers, both male and female.
Apr 18, '13do not assume or relate the symptoms to a definite medical condition, this will just isolate one of the symptoms that the patient is displaying, but instead, run tests that is applicable to the patient's symptoms and conditions to determine the cure that must be applied onto the patient...
Apr 21, '13Check into primary amebic meningoencephalitis (PAM), particularly Naegleria Fowleri. Over a year ago, we had a case with similar presentation as you described and usual work up showing nothing. It turned out to be PAM.
Apr 21, '13Sorry that I haven't updated sooner.
There hasn't been any official diagnosis. However, I'm happy to report that the patient who was on our unit (actually the most recent patient to present with these symptoms, was able to be extubated after about two weeks. Other than some rapidly improving physical deficits, he appears completely intact neurologically- responding appropriately to questions and recognizing family members as soon as he was awake enough. I don't have an update about the other cases, since they aren't at our hospital anymore, but it's looking more and more likely that we may never actually find out what caused this in the first place.
Thanks for your thoughts and your input, as always.
Apr 22, '13My first thought on reading this is Spider Bite? from the very poisonous Telamonia Dimidita. Just a guess
May 5, '13Please read the cdc's page on dengue fever. Even though it is a typically tropical disease, the environmental disaster Sandy left behind could be the culprit.