Post-Enterovirus Polio-like Rhombencephalitis in a 6 Year-old

A 6-year old, intubated patient with intermittent CPR-necessity was admitted to the intensive care ward. He had fallen sick one week earlier with flu-like symptoms, which had progressed to head- and neck pain as well as vertigo. Furthermore he developed dyspnoea, hypersalivation, dysphagia and desaturations while failing non-invasive ventilation, leading to his intubation. Guillain-Barré-syndrome was assumed, IVIG given and extended with 3 days Methylprednisolone. Additionally 10 cycles of plasmapheresis were performed leading to a rapid improvement of recurrent reanimation necessary bradycardic-/asystolic events. Cerebral and spinal MRI showed signal alterations/oedema of the cervical anterior horn (2^nd motor neuron) from C2 to C5 as well as signal alterations of tegmentum pontis and medulla oblongata, suspicious for rhombencephalitis and anterior myelitis (Figure 1). At this point, the patient showed (sub)-total paralysis with only movement of a few hand and facial muscles. PCR screening for pathogens in tracheal fluid detected enterovirus and literature associates the MRI lesions with enterovirus D-68 infection. During weaning our patient demonstrated lack of diaphragmatic movement and thus effective breathing, which led to prolonged necessity of nasotracheal intubation and later on tracheostomy with (home)-ventilation. PEG tube was installed since he was unable to swallow effectively without risk of aspiration. Extensive rehabilitative therapies were initiated, leading to significant improvement of movement but remaining home-ventilation dependent. After 3 months on intensive care, he could be transferred to a rehabilitation clinic.