Case of the Week: Acute Flaccid Paralysis

(By Alyssa)

I met Claudine on one of the first days I rounded on pediatrics. She was 4 years old and I was immediately struck by how sick she was. She had been admitted severely anemic (Hemoglobin of 3) with a diagnosis of malaria. As she was comatose and had had several seizures, she was also treated for meningitis. She had already received a blood transfusion and a couple days of IV medications by the time I saw her but she was still completely unresponsive. She required intubation and mechanical ventilation but that’s not possible here. I spoke with the family explaining the gravity of her condition and we prayed with them together as a team. I alerted the on-call doctor and asked him to keep a close eye on her - he was called to evaluate her several times due to high fever, difficulty breathing, and seizures. I really didn’t expect Claudine to survive. But each morning I came back to pediatrics and found her still there. She began to open her eyes and look around the room. But she still didn’t speak or move. We discovered one day that she actually could follow commands with her eyes. But she was completely paralyzed to the point of being unable to swallow or speak. Possibly a post-infectious Guillian-Barré syndrome, possibly something else. We needed to give her nutrition somehow as it had now been over a week since she had been able to eat or drink anything. I discovered some pediatric nasogastric tubes in the back supply room. The nurses had never placed or used an NG tube before, so I inserted it and explained it to them. But then I realized we didn’t have any formula to put in it nor was there any milk available (cows produce very little milk here) and the family couldn’t afford to buy milk. So I talked with my teammates and the families agreed to donate milk each day for this little girl. Anna even helped me deliver it to her one day. And we taught the mother how to put the milk in the NG tube. After a few days, Claudine regained the ability to swallow, so we removed the tube and she was able to eat. The last day of her hospitalization she could speak very softly and barely move one hand. 

She came back today for a follow up visit and I feared she would be emaciated and still extremely weak. But, amazingly, miraculously, she looked like a completely normal 4 year old girl! Walking, talking, active - I wouldn’t have even known it was her if I hadn’t recognized her mother. I loved sharing this excitement over her healing with the pediatric team as the medical students and nurses rejoiced with us. We praise God for bringing healing to her and for reminding us in this way of His love for these precious children.