Disclosures: Megan E. Kennelly, MD: No financial relationships or conflicts of interest

Case Diagnosis: 2-year-old female with infantile polyarteritis nodosa who developed acute paraplegia secondary to T10 spinal cord infarction.

Case Description or Program Description: The patient, with a recent history of pontine stroke and toe auto-amputation due to vasculitis, presented to acute care with bilateral lower extremity mottling and altered mental status. She was found to have a flare of her vasculitis and was started on immunosuppressive therapy. Despite treatment, she developed acute paraplegia. MRI spine showed T2 hyperintensity and restricted diffusion at T10 consistent with spinal cord infarct.

Setting: Large academic medical center and inpatient pediatric rehabilitation unit

Assessment/Results: After 58 days in an acute hospital, the patient was admitted to comprehensive inpatient rehabilitation. She tolerated a multi-disciplinary program for spinal cord injury, while also being monitored for acute flares of vasculitis. She required careful daily monitoring of limb perfusion. While admitted, her caregiver learned intermittent catheterization for management of neurogenic bladder. She was discharged home at a contact-guard assist level for wheelchair mobility after 16 days.

Discussion (relevance): Infantile polyarteritis nodosa is a rare life-threatening vasculitis with multi-organ involvement. The systemic form of the disease can cause severe neurologic sequelae including stroke. While spinal cord infarction has been reported as a complication of polyarteritis nodosa, reports of this in the pediatric population are exceptionally rare. This patient, with paraplegia due to spinal cord stroke, also had history of intracranial stroke and digit loss due to ischemia. Despite the significant morbidity associated with infantile polyarteritis nodosa, inpatient rehabilitation was well-tolerated in this case.

Conclusions: Polyarteritis nodosa can cause many conditions often managed by a pediatric physiatrist, including late effects of stroke and limb infarction. Spinal cord infarction is rare in infantile polyarteritis nodosa, but inpatient rehabilitation can be well tolerated with appropriate multidisciplinary supports.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/spinal-cord-infarct-in-infantile-polyarteritis-nodosa-a-case-report/