Poliomyelitis-like paralysis during recovery from acute bronchial asthma: possible etiology and risk factors.

A poliomyelitis-like paralytic disease during recovery from an attack of bronchial asthma is described in two young children. They presented at the age of 13 and 22 months, respectively, with acute flaccid paralysis of one or both lower limbs and preserved sensation. Cerebrospinal fluid examinations revealed mild protein elevation in both and pleocytosis in the second infant. Enteroviruses were isolated in a nasal swab and stools of the second patient. Acute onset of flaccid paralysis with absent motor action potential and normal sensory responses, detected by electrophysiologic studies, are highly suggestive of motor anterior horn cell disease in these infants. A multifactorial setup of immune suppression, stress, and neurotoxic drugs during an acute bronchial asthma attack triggered by a viral disease may render the patient vulnerable to viral invasion of the anterior horn cell with enteroviruses other than poliovirus. The overall experience of 22 patients with this serious complication is reviewed.

Ultrastructural and immunofluorescent studies of acute and chronic lactate dehydrogenase elevating virus-induced nonparalytic poliomyelitis in mice.

Light microscopic, electron microscopic, and immunofluorescent studies have been performed on young C58/J mice following administration of cyclophosphamide and peripheral inoculation of the C strain of lactate dehydrogenase-elevating virus (LDV-C). Using special fixation techniques, all three types of studies were performed on the spinal cord tissues obtained from the same mice. LDV-C infection-specific immunofluorescence was detected in anterior horn neurons. Ultrastructurally, anterior horn neurons during the acute inflammatory phase of the disease were characterized by various degrees of chromatolysis, an increase in the number of lamellar inclusion bodies, and extensive membrane proliferation of perinuclear endocytoplasmic reticulum. A chronic vacuolar appearance of the anterior horn was due to intraneuronal vacuolation as well as vacuolation of the neuropil; these changes may have been due to expansion of proliferated intracytoplasmic membranes and/or focal ischemia secondary to the acute inflammatory response. Direct evidence was obtained that indicated the cytopathology was not immune mediated in that highly poliomyelitis-susceptible 18-month-old C58/J mice developed severe paralysis without inflammation of the spinal cord when treated with cyclophosphamide before infection.