Rhombencephalitis, neuromyelitis optica and hypothyroidism following Coxsackie virus infection

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.

Keywords

Rhombencephalitis - neuromyelitis optica - hypothyroidism - Coxsackie virus