Disclosures: Britney Papp, DO: Nothing to disclose

Case Description: Patient initially presented with complaints of bilateral lower extremity weakness, nausea, vomiting and diarrhea. Patient had a history of recurrent spells of lower extremity weakness and numbness for approximately 1 month prior to presentation. At time of admission, potassium was found to be 2.5 and subsequently supplemented. Exam demonstrated diminished vibratory and sensory sensation in bilateral lower extremities symmetric extending up to the top of the thigh. Patient did have urinary retention and bowel incontinence. Patient had 2+ reflexes in bilateral upper extremity, but 0+ patella and Achilles reflexes bilaterally. Patient had a prior diagnosis of lupus and previously been treated on Plaquenil and CellCept however, all treatments were stopped approximately 6 months prior to presentation. Lumbar puncture was unremarkable. Patient could not undergo MRI due to incompatible AICD. Cervical, thoracic, lumbar spine CT scans without acute abnormality.

Setting: Tertiary care hospital

Patient: A 31-year-old African American female with familial nonischemic cardiomyopathy status post pacemaker and prior diagnosis of lupus.

Assessment/Results: Patient was empirically treated for transverse myelitis (TM) with prednisone 1g daily for 3 days and then a steroid taper. EMG was essentially unremarkable. Patient underwent inpatient rehabilitation and did have return of reflexes at the patella and Achilles as well as gradual return of strength.

Discussion: Patient with antecedent gastroenteritis with progressive lower extremity paresis. Patient’s case was complicated by the AICD with atrial lead incompatible for MRI and a family history of hypokalemic periodic paralysis. Patient was empirically treated for TM and clinical symptoms over the hospital course did improve, though hypokalemia was also corrected in that time.

Conclusion: In approximately 50 percent of TM cases, there is an antecedent respiratory, gastrointestinal (GI), or systemic illness. The GI symptoms the patient was displaying could lead to a worsening hypokalemia and concomitant hypokalemic periodic paralysis, which is inherited in an autosomal dominant pattern.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-case-of-acute-flaccid-paralysis-due-to-transverse-myelitis-with-concomitant-hypokalemic-periodic-paralysis/