Transverse Myelitis in the Setting of Enterobius vermicularis (Pinworm) Infection: Case Report.

Myelitis is a rare inflammatory myelopathy, and known associated etiologies only account for a small number of causes. A significant percentage of cases have an unknown etiology and are considered idiopathic. With 64% to 68% of cases fitting into the idiopathic category, helminth infections, and specifically pinworm parainfections, should be considered in cases that would otherwise be classified as idiopathic. This case report outlines a pediatric patient diagnosed with myelitis given her progressive weakness, fussiness, refusal to bear weight as well as magnetic resonance imaging (MRI) demonstrating T2-hyperintense signal and/or T1 gadolinium enhancement, and/or positive cerebrospinal fluid (CSF) inflammatory markers. This patient had a negative evaluation for typical known etiologies for myelitis including no signs of multiple sclerosis and neuromyelitis optica spectrum disorder on brain MRI, oligoclonal banding and aquaporin-4 autoantibodies, and no evidence of bacterial or viral meningitis given normal cell counts and cultures in CSF. She was found to have a pinworm infection, suggesting a parasitic parainfectious etiology of her myelitis. This case outlines the first case noting the correlation between myelitis and pinworm infection in a pediatric patient.

Delayed Onset of Pediatric Morel-Lavallée Lesion: A Case Report.

Introduction: A Morel-Lavallée lesion (MLL) is a closed degloving injury secondary to shearing forces. MLL is a rare, easily overlooked diagnosis, especially in those without recent trauma or fracture. Patients will present with ecchymosis, edema, fluctuance, and skin hypermobility or tightness. We present a case of pediatric MLL that was initially challenging to diagnose as the inciting trauma was 2 months before her diagnosis. Case Report: A 14-year-old girl presented with 5 days of left leg bruising, swelling, and pain. Two months prior, she collided with another softball player's cleat and developed a hairline fracture. Magnetic resonance imaging of the left lower extremity (LLE) showed a closed, soft-tissue degloving injury, and she was diagnosed with a MLL. Throughout her admission, she had improvement in her bruising but continued to have pain with ambulation that was somewhat alleviated with the use of a compression stocking. Pediatric Orthopedic Surgery and Interventional Radiology were consulted, and a conservative approach was recommended with 3 months of LLE compression. Conclusion: MLL typically occurs in patients in their 30-40s and rarely occurs in children. Identifying MLL in children is essential as children are more susceptible to shock and multi-organ damage from blunt trauma than adults. They are also more vulnerable to fractures and deep organ injuries. In the setting of MLL, children can quickly develop hypovolemic shock due to lower blood volumes and necrosis secondary to mass effect in the dead space. MLL should be included on the differential for children with trauma or a history of a shearing injury.