A 3-year-old boy with acute flaccid paralysis of the right lower limb developing one week after treatment and recovery from an acute asthma attack is reported from the Department of Child Health, Milton Keynes General Hospital, UK. Sensation was normal, plantar responses were flexor, deep tendon reflexes were absent in the involved limb, and meningeal signs were negative. MRI of the spine was normal. EMG was consistent with anterior horn cell damage and persisting amyotrophy. Mycoplasma complement fixation test titer and agglutination titer were significantly increased. Erythromycin treatment was without benefit, and paralysis persisted at 12 month follow up. [1]
COMMENT. Since the first description of 10 cases of a poliomyelitis-like illness associated with acute asthma in childhood (Hopkins IJ, 1974), 18 additional reports of Hopkins syndrome have been published. Non-polio enteroviruses, varicella and herpes virus type 1 have been implicated in some cases. Mycoplasma is known to exacerbate asthma and has been linked to various neurological disorders, including Guillain-Barre syndrome and transverse myelitis. Amyotrophy and Hopkins syndrome are additional complications of Mycoplasma infection.