Myelitis due to coxsackievirus B infection

Enteroviruses, including polioviruses, coxsackieviruses A and B, echoviruses, and more recently discovered enteroviruses, are neurotropic, but there are only a few cases of flaccid paralysis reported in association with coxsackievirus. We present a 12-year-old girl with an unusual clinical presentation of this rare complication. MRI findings were consistent with the clinical picture. ### Case report. In October 1993, a 12-year-old girl presented with paralysis of both arms developing over a few hours' time, without affecting the legs. There was nothing unusual in her medical history. She had received all vaccinations in a normal way; in particular, the oral, live attenuated poliovirus vaccine was given at 3, 5, and 13 months of age. Two weeks before onset, she had complained of a sore throat and had coughed for a few days. There was no fever or diarrhea. The morning of onset of the paralysis she experienced interscapular pain radiating to the shoulders. In the next few hours, weakness of the arms developed. The patient's mental status was normal. There was no fever, headache, or meningism. Significant flaccid paralysis was present in the upper extremities only. Deep tendon reflexes were diminished or absent in the upper extremities and normal in the lower extremities. There were no Babinski signs. Superficial abdominal reflexes were present. There was a hypoesthesia for touch, pain, and temperature below C-6 …