The muscle findings in a pediatric patient with live attenuated oral polio vaccine-related flaccid monoplegia

A pediatric patient, who was given live-attenuated oral polio vaccine twice without distinct gait disturbance during infancy, begun to present limp at 3 years. His gait disturbance became remarkable with aging. At 7 years, he was unable to dorsiflex the left ankle, and presented flaccid monoplegia of the left lower extremity, and the left Achilles tendon reflex was diminished. Magnetic resonance imaging revealed multiple crack-lines in the left anterior tibial muscle, but was unable to detect any distinct lesion at responsible level of L4, L5 and S1 anterior horn cells' degeneration. Electromyography showed continuous fibrillation potentials, but muscle biopsy presented nearly normal in this muscle. The serum levels of polio antibody type 1 and type 2 titers were elevated 64x respectively, while the type 3 antibody titer was not elevated 4x. This patient was diagnosed as live attenuated oral polio vaccine-related flaccid monoplegia, with mild clinical course. (C) 2014 Elsevier Ltd. All rights reserved.