Rotavirus and Afebrile Seizure… The Missing Link Found

Abstract

Objective: To raise awareness on the neurologic manifestations of a common gastrointestinal pathogen. Design: Case Report Setting: Department of Pedictrics Case Summary: This is a case of a 2-year old girl admitted due to upward rolling of the eyeballs and stiffening of extremities. Four days prior to admission, she had four episodes of non-projectile vomiting of previously ingested milk. There was no other associated sign or symptom. Three days prior to admission, she was no longer vomiting but had 4 episodes of yellowish to greenish, non-mucoid and non-blood streaked watery-based stools. She was brought to a private physician and was advised oral rehydration solution which she tolerated. The diarrhea persisted, prompting another consult one day prior to admission. She had normal urinalysis and was told to continue the ORS as needed. A few hours prior to admission, she had upward rolling of eyeballs and stiffening of all extremities lasting for 2 minutes. She was to the ER and was subsequently admitted. She had 2 previous admissions for seizures: benign febrile convulsion secondary to acute gastroenteritis at 11 months old and an afebrile seizure at 2 years during another bout of gastroenteritis. She was seen by a neurologist and was worked up. However, her EEG, blood count, stool examination, urinalysis and electrolytes were all normal. This 2-year old girl had a history of recurrent seizures associated with diarrhea. She had no neurological deficit after each occurrence. Above case presented with afebrile seizures during episodes of diarrhea. Patient did not have significant electrolyte disturbance and the stool was positive for rotavirus antigen. The first report of central nervous system involvement after rotavirus infection was made in 1978. Since then, this association has been described by several authors. Studies have reported various frequencies of CNS involvement in children with acute rotavirus gastroenteritis. Conclusion: This case was reported with recurrent seizures associated with diarrhea on a 2 year old girl. The physical and neurologic examinations were normal. The stool exam was positive for rotavirus antigen. In the evaluation of afebrile seizures, we must be aware of common pathogens with rare manifestation.