当心小儿跛行:一例支原体相关的急性横贯脊髓炎。

Journal of education & teaching in emergency medicine Pub Date : 2025-07-31 eCollection Date: 2025-07-01 DOI:10.21980/J8QQ1Q
Michael Neff, Nicholas Xie, Joseph Fong, Gregory Podolej
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引用次数: 0

摘要

步态障碍在儿科患者可以与广泛的感染性,创伤性,肌肉骨骼和神经学的病因诊断陷阱。此外,孩子们可能很难表达他们的痛苦,也很难检查。这个病例强调了慢下来获取详细病史以及对我们的儿科患者进行彻底检查的重要性,这在繁忙的急诊科可能是具有挑战性的。我们提出一个病例急性横断脊髓炎(ATM)在一个四岁的男性谁提出了一天的跛行和双侧腿痛与负重。看护人报告说可能是日托所里的斗殴造成的远端创伤。神经学检查显示明显异常,包括双侧髌骨反射亢进、双侧下肢无力、阵挛和步态失调。脑和脊柱MRI显示纵向广泛的ATM伴脊髓水肿。尽管缺乏感染前驱症状的证据,但脑脊液感染分析显示肺炎支原体是病原体。静脉注射(IV)甲基强的松龙和阿奇霉素治疗导致出院后几周内所有神经系统后遗症的最终解决。本报告强调了在鉴别以步态疾患为表现的儿科患者时考虑ATM的重要性,以及彻底的神经学检查的重要性,否则诊断将被错过。主题:小儿急诊医学、小儿神经病学、急性横断面脊髓炎、小儿步态障碍。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Beware of the Pediatric Limp: A Case of <i>Mycoplasma</i> Associated Acute Transverse Myelitis.

Beware of the Pediatric Limp: A Case of <i>Mycoplasma</i> Associated Acute Transverse Myelitis.

Beware of the Pediatric Limp: A Case of <i>Mycoplasma</i> Associated Acute Transverse Myelitis.

Beware of the Pediatric Limp: A Case of Mycoplasma Associated Acute Transverse Myelitis.

Gait disturbances in pediatric patients can be wrought with diagnostic pitfalls given the broad infectious, traumatic, musculoskeletal, and neurological etiologies. Furthermore, children can have difficulty communicating their pain and can be hard to examine. This case highlights the importance of slowing down to obtain a detailed history as well as perform a thorough exam in our pediatric patients, which can be challenging in a busy emergency department. We present a case of acute transverse myelitis (ATM) in a four-year-old male who presented with a one-day history of limp and bilateral leg pain with weight bearing. The caretakers reported a possible remote trauma from roughhousing at daycare. Neurological examination revealed significant abnormalities including bilateral patellar hyperreflexia, bilateral lower extremity weakness, clonus, and gait ataxia. A brain and spinal MRI revealed longitudinally extensive ATM with cord edema. Despite the lack of any evidence of infectious prodrome, cerebrospinal infectious analysis revealed Mycoplasma pneumonia as the causative agent. Treatment with intravenous (IV) methylprednisolone and azithromycin therapy led to eventual resolution of all neurological sequelae within a few weeks of discharge. This report emphasizes the importance of considering ATM in the differential of pediatric patients presenting with gait complaints, as well as the importance of a thorough neurologic exam, without which the diagnosis would have been missed.

Topics: Pediatric emergency medicine, pediatric neurology, acute transverse myelitis, pediatric gait disturbance.

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