Affiliations: Department of Neurology, Sanjay Gandhi PGIMS, LKO,
India | Department of Microbiology, Sanjay Gandhi PGIMS, LKO,
India
Note: [] Correspondence: Usha K. Misra, Prof. & Head, Department of
Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences,
Raebareily Road, Lucknow- 226014, India. Fax: +91 0522 2668017; E-mails:
ukmisra@sgpgi.ac.in, drukmisra@rediffmail.com
Abstract: A 7-year-old girl presented with swallowing and respiratory
difficulty necessitating artificial ventilation. Her cranial magnetic resonance
imaging revealed T2 hyperintensity in the brainstem and cerebrospinal fluid
polymerase chain reaction was positive for Coxsackie B4 virus infection. She
improved spontaneously by one month. Six months later, she was readmitted with
features of primary hypothyroidism and neuromyelitis optica. She improved
following corticosteroid and levothyroxine treatment. After 8 months, she had
another attack of neuromyelitis optica following withdrawal of prednisolone.
Cranial magnetic resonance imaging, cerebrospinal fluid oligoclonal band and
vasculitis profile were negative during this attack. She improved following a
course of methyl prednisolone. This association of neuroendocrinal
manifestations may be due to immunological alterations triggered by Coxsackie
B4 virus infection.
