Case Report: Is Intravenous Immunoglobulin Important when Used Together with Pulse Steroid! Complete recovery within 1 Month of Pediatric Patient Diagnosed with Transverse Myelitis

Abstract

BACKGROUND: Pediatric acute transverse myelitis (ATM) is a potentially devastating condition with variable outcomes and presents significant demands on health and social care resources.

CASE PRESENTATION: The patient in the present study was a 9-year-old boy, unknown to have chronic diseases. He was presented to Maternity and Children Hospital, Tabuk, with a history of acute progressive onset of unsteady gait and imbalance with pictures of encephalopathy. “Change level of consciousness” for >1 week, preceded by fever and upper respiratory tract infection symptoms. Physical findings were very suggestive and consistent with ATM. Diagnosis was confirmed by blood investigations, lumbar puncture analysis, and magnetic resonance imaging (MRI) brain, and spine. The analysis of lumbar puncture (cerebrospinal fluid) showed high white blood cells count and high protein level “more than 500.” The findings of MRI brain and spine were consistent with TM. The treatment was done initially with intravenous immunoglobulin (IVIG) by a dose of 2 g/kg divided over 2–4 days; followed by a dose of IV pulse steroid, 30 mg/kg/dose of methylprednisolone once a day for 3 days, with close monitor. The patient had a full physical and radiological recovery within less than one month. In conclusion, IVIG showed a significant role in the management of ATM together with steroid.

CONCLUSION: IVIG showed a significant role in the management of ATM and could be used as a supportive treatment together with IV pulse steroid. IVIG showed a good efficacy with no serious complications.