What is wrong with these kids? (Mystery Diagnosis) - page 2

by Ashley, PICU RN

12,567 Views | 49 Comments

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... Read More


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    very curious about the outcome/diagnosis if one is made. Have seen a few bizarre cases where it seemed every specialty was on board and no one knew what was going on and tests came back negative. I do not want to get too specific but like in Esme's example a foreign physician diagnosed it as he had seem this many times while practicing in Asia. It is apparently a super rare disease in America or most of the western world.
    Esme12 and Blue Roses like this.
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    I've seen kids who present like this who are ultimately found to have anti-NMDA receptor encephalitis. Treatment is usually a combination of IVIG, high dose steroids and/or plasmapheresis.
    anotherone, tewdles, and Esme12 like this.
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    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
    A
    nd some basic info from Wiki, http://en.wikipedia.org/wiki/Anti-NMDA_receptor_encephalitis
    W
    hatever it is, glad you are working so hard to figure it out.
    tewdles likes this.
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    ^Very interesting! Sometimes the below the radar illnesses can be frustrating to investigate.
    anotherone likes this.
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    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.....
    anotherone and tewdles like this.
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    Botulism comes to my mind as well.
    anotherone, Esme12, and marycarney like this.
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    ^^ ditto ^^ botulism maybe???

    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.
    Esme12 and RunnerRN2b2014 like this.
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    None taken I agree....I love to rack my brain for answers.
    RunnerRN2b2014 and tewdles like this.
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    What about something like Reye's Syndrome?
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    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.
    Esme12 and marycarney like this.


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