Acquired quadriparesis in a child with unusual presentation

Introduction Acute onset quadriparesis can be a manifestation of a variety of neurological, metabolic or autoimmune conditions. Rarely, it could be one of many clinical presentations of juvenile dermatomyositis which belongs to the group of idiopathic inflammatory myopathies of childhood. We report...

Full description

Bibliographic Details
Main Authors:	Anuar, Muhamad Azamin, Wan Nik Ahmad Mustafa, Wan Alina Khadijah, Abu Bakar, Asrar, Hasan, Taufiq Hidayat, Mohamed, Mossad Abdelhak Shaban
Format:	Conference or Workshop Item
Language:	English English
Published:	2019
Subjects:	RJ Pediatrics RJ101 Child Health. Child health services
Online Access:	http://irep.iium.edu.my/75192/ http://irep.iium.edu.my/75192/7/PP180%20-%20Muhamad%20Azamin%20Anuar.pdf http://irep.iium.edu.my/75192/13/JDM%20poster%20-%2075192.pdf

id	iium-75192
recordtype	eprints
spelling	iium-751922020-02-26T07:07:30Z http://irep.iium.edu.my/75192/ Acquired quadriparesis in a child with unusual presentation Anuar, Muhamad Azamin Wan Nik Ahmad Mustafa, Wan Alina Khadijah Abu Bakar, Asrar Hasan, Taufiq Hidayat Mohamed, Mossad Abdelhak Shaban RJ Pediatrics RJ101 Child Health. Child health services Introduction Acute onset quadriparesis can be a manifestation of a variety of neurological, metabolic or autoimmune conditions. Rarely, it could be one of many clinical presentations of juvenile dermatomyositis which belongs to the group of idiopathic inflammatory myopathies of childhood. We report the case of a 9-year old girl who presented with global myopathy over a two-month period. Case summary A 9-year-old girl referred from Orthopaedic team with a 2 months history of generalised muscular pain and weakness. There were no significant history of preceded illness, trauma or excessive strenuous exercises. She had no other systemic complaints such as fever or skin rash. Past medical history was unremarkable except for recurrent tonsillitis. Physical examination revealed a child with normal alertness and behaviour. She did not appear meningitic nor encephalopathic. She has notable generalised swelling of all four limbs. Her neurological examination revealed normal tone however her power was definitely reduced in all four limbs (Graded 3/5). Significantly, she demonstrated signs of proximal myopathy. Subsequent investigations revealed high Creatinine Kinase (CK) levels of 6470U/L, ESR 84mm/hr with deranged transaminases and positive serum mycoplasma and CMV IgM. Her MRI brain and spine along with lumbar puncture results were normal. She was referred to tertiary centre for further evaluation as her weakness progressed. An MRI muscle was performed demonstrating marked inflammation in all four limbs including paravertebral muscular regions. Her muscle biopsy showed inflammatory myopathy leading to a diagnosis of juvenile dermatomyositis (JDM). She is now showing sustained clinical improvements following a course of immunoglobulin and corticosteroids therapy. Conclusion The diagnosis of JDM is generally considered in patients with typical rash on the face or body along with symmetrical muscle weakness. Diagnostic criteria in JDM are currently being revised due to further adjustment required for new outcome tools. Essentially, it involves assessment of muscle, skin, lung and cardiac involvement on top of baseline list of investigations that has been outline by Single Hub and Access point for pediatric Rheumatology in Europe (SHARE). This case reflects that JDM is possible despite non-existent of skin involvement. 2019 Conference or Workshop Item NonPeerReviewed application/pdf en http://irep.iium.edu.my/75192/7/PP180%20-%20Muhamad%20Azamin%20Anuar.pdf application/pdf en http://irep.iium.edu.my/75192/13/JDM%20poster%20-%2075192.pdf Anuar, Muhamad Azamin and Wan Nik Ahmad Mustafa, Wan Alina Khadijah and Abu Bakar, Asrar and Hasan, Taufiq Hidayat and Mohamed, Mossad Abdelhak Shaban (2019) Acquired quadriparesis in a child with unusual presentation. In: 15th Asian Oceanian Congress of Child Neurology in conjunction with the 41st Malaysian Paediatric Association Annual Congress 2019 “Synergy to Challenge Boundaries in Child Neurology”, 19th-22nd September 2019, Kuala Lumpur. (Unpublished)
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English English
topic	RJ Pediatrics RJ101 Child Health. Child health services
spellingShingle	RJ Pediatrics RJ101 Child Health. Child health services Anuar, Muhamad Azamin Wan Nik Ahmad Mustafa, Wan Alina Khadijah Abu Bakar, Asrar Hasan, Taufiq Hidayat Mohamed, Mossad Abdelhak Shaban Acquired quadriparesis in a child with unusual presentation
description	Introduction Acute onset quadriparesis can be a manifestation of a variety of neurological, metabolic or autoimmune conditions. Rarely, it could be one of many clinical presentations of juvenile dermatomyositis which belongs to the group of idiopathic inflammatory myopathies of childhood. We report the case of a 9-year old girl who presented with global myopathy over a two-month period. Case summary A 9-year-old girl referred from Orthopaedic team with a 2 months history of generalised muscular pain and weakness. There were no significant history of preceded illness, trauma or excessive strenuous exercises. She had no other systemic complaints such as fever or skin rash. Past medical history was unremarkable except for recurrent tonsillitis. Physical examination revealed a child with normal alertness and behaviour. She did not appear meningitic nor encephalopathic. She has notable generalised swelling of all four limbs. Her neurological examination revealed normal tone however her power was definitely reduced in all four limbs (Graded 3/5). Significantly, she demonstrated signs of proximal myopathy. Subsequent investigations revealed high Creatinine Kinase (CK) levels of 6470U/L, ESR 84mm/hr with deranged transaminases and positive serum mycoplasma and CMV IgM. Her MRI brain and spine along with lumbar puncture results were normal. She was referred to tertiary centre for further evaluation as her weakness progressed. An MRI muscle was performed demonstrating marked inflammation in all four limbs including paravertebral muscular regions. Her muscle biopsy showed inflammatory myopathy leading to a diagnosis of juvenile dermatomyositis (JDM). She is now showing sustained clinical improvements following a course of immunoglobulin and corticosteroids therapy. Conclusion The diagnosis of JDM is generally considered in patients with typical rash on the face or body along with symmetrical muscle weakness. Diagnostic criteria in JDM are currently being revised due to further adjustment required for new outcome tools. Essentially, it involves assessment of muscle, skin, lung and cardiac involvement on top of baseline list of investigations that has been outline by Single Hub and Access point for pediatric Rheumatology in Europe (SHARE). This case reflects that JDM is possible despite non-existent of skin involvement.
format	Conference or Workshop Item
author	Anuar, Muhamad Azamin Wan Nik Ahmad Mustafa, Wan Alina Khadijah Abu Bakar, Asrar Hasan, Taufiq Hidayat Mohamed, Mossad Abdelhak Shaban
author_facet	Anuar, Muhamad Azamin Wan Nik Ahmad Mustafa, Wan Alina Khadijah Abu Bakar, Asrar Hasan, Taufiq Hidayat Mohamed, Mossad Abdelhak Shaban
author_sort	Anuar, Muhamad Azamin
title	Acquired quadriparesis in a child with unusual presentation
title_short	Acquired quadriparesis in a child with unusual presentation
title_full	Acquired quadriparesis in a child with unusual presentation
title_fullStr	Acquired quadriparesis in a child with unusual presentation
title_full_unstemmed	Acquired quadriparesis in a child with unusual presentation
title_sort	acquired quadriparesis in a child with unusual presentation
publishDate	2019
url	http://irep.iium.edu.my/75192/ http://irep.iium.edu.my/75192/7/PP180%20-%20Muhamad%20Azamin%20Anuar.pdf http://irep.iium.edu.my/75192/13/JDM%20poster%20-%2075192.pdf
first_indexed	2023-09-18T21:46:23Z
last_indexed	2023-09-18T21:46:23Z
_version_	1777413477905727488

Acquired quadriparesis in a child with unusual presentation

Similar Items