Age: 0.58
Sex: M
Vaccine: DTAP
Symptoms: Asthenia, Constipation, Hypokinesia, Laboratory test abnormal, Myelitis transverse
Clinical narrative: Initial literature report was published on 29 November 2005. The article was a case report of a 7 month sold boy, who developed acute transverse myelitis after DTP immunization. A 7 month male without any significant past medical history, was admitted on an unspecified date, to a hospital for leg weakness. He received Dtap vaccine lot U0952AA 17 days prior to admission. Based on the clinical course and MRI findings, the diagnosis of acute transverse myelitis was made. Previous Dtap doses given at the age of 2 and 4 months were well tolerated. he had an upper respiratory tract infection 2 weeks prior to admission. He initially developed constipation for which he was admitted to the local hospital and fleet enemas were given. Subsequently, he developed urinary dribbling, priapism, and lower extremity weakness. he had no breathing or feeding difficulties. He was than transferred to the reporters hospital. So far, his developmental milestones had been normal. Birth maternal and prenatal history had all been unremarkable. Family history was negative for neuromuscular disease or for any recent illnesses. His parents and 7 year old sister had been well. He had no known dug allergies and was not on nay medications. On admission, he was alert, smiling, and was focusing and tracking well. He was not dysmorphic and he did not have any neurocutaneous stigmata. Pulmonary, cardiovascular, and abdominal examinations were normal. A detailed examination of his back did not reveal any abnormalities. He had priapism and urine was intermittently dribbling from the urethral meatus. He had flaccid paraplegia and he exhibited a triple flexion response to noxious stimulation of the lower extremities. Deep tendon reflexes were +1 on lower extremities and +2 on the upper extremities. Plantar responses were equivocal and no clonus was elicited. He had no abdominal reflexes. Cremasteric reflexes were present bilaterally. Anal tone was patulous and no anal wink was elicited. Laboratory evaluation included a complete blood count showing an increased white blood count of 16000 with 67% neutrophils. Comprehensive metabolic panel, erythrocyte sedimentation rate, urinalysis, and C reactive protein were all normal. Cerebrospinal fluid analysis showed two red blood cells/pl, seven white blood cells/pI with four lymphocytes and three monocytes, glucose of 63 mg/dl and a total protein of 30 mg/dl. Cerebrospinal fluid oligoclonal bands were negative and IgG index. The patient's MRI features showed preservation of cord architecture with a homogenously abnormal signal of T2 weighted images, patchy gadolinium enhancement and the lack of vascular channels made a neoplasm and arterio venous fistulas unlikely. Follow up MRI performed 3 months later also showed resolution of the above abnormalities (dema and signal) although the spinal cord appeared of smaller caliber. Urologic symptoms improved with steroids but motor function was never fully regained.  The reporter was not able to discover an associated agent despite an extensive diagnostic workup.