Nothing cute about it: Acute flaccid myelitis

Case presentation

A 2-year-old child presents with difficulty ambulating for the past 24 hours. His parents state that the child has had fever, cough, and congestion for the past 5 days. He was seen twice by his primary care provider and diagnosed with a viral upper respiratory infection. A chest x-ray 1 day ago was interpreted as consistent with a viral process. The parents tell you that the child had had no bowel movement for the past 2 days, and today, in addition to his difficulty ambulating, he has not urinated. They also tell you that the child began to indicate soreness or discomfort in his arms and his legs.

Physical examination is remarkable for a quiet child, who, while not toxic, does not want to ambulate. He does not appear to be in obvious distress. He has a temperature of 102 degrees Fahrenheit and a heart rate of 130 beats per minute. His neurologic examination is significant for diminished strength throughout, although he is able to sit up. He appears to have equal tone. Reflexes are diminished bilaterally. Sensation is grossly intact. There are no rashes.

Imaging considerations