SHM Converge Scientific Abstract ePoster Gallery-Toddler Troubles: A Curious Case of Refusal to Walk

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A previously healthy 16-month-old girl developed refusal to walk after falling backward from a high bed. Over the next few days she became fussy, less active, and ate less, but she had been walking normally before the injury. Exam showed tenderness and swelling over the lower thoracic spine, discomfort with movement, and leg posturing when placed upright, but normal strength, tone, reflexes, and no rash.<br /><br />The initial differential was broad and included trauma, infection, inflammatory disease, neurologic causes, toxic exposure, and malignancy. Laboratory studies showed mild anemia, elevated ESR, normal CRP, and normal CK. X-rays, hip ultrasound, and MRI of the total spine were unremarkable. Because she improved only minimally with observation and pain control, further imaging was performed one week later. MRI of the brain was normal, but MRI of the lower extremities showed extensive inflammatory changes in the pelvic girdle, thighs, and legs, suggesting myositis. An extended myositis panel revealed anti-MDA5 antibodies. Muscle biopsy one month later confirmed juvenile dermatomyositis (JDM).<br /><br />This case highlights that JDM can present atypically in very young children and may initially lack classic skin findings. Anti-MDA5-associated JDM is notable for lower CK levels, cutaneous disease, and risk of interstitial lung disease, which makes early recognition important. The poster emphasizes the need to consider inflammatory myopathies in toddlers who suddenly refuse to walk, even when initial imaging is normal and trauma seems like the most likely explanation. Early diagnosis and treatment with corticosteroids and other immunosuppressive therapy are essential to prevent complications.

Asset Subtitle

Amy Lipman

Meta Tag

Author List Amy Lipman, Mirna Giordano, William Fyke

Category Clinical Vignettes

Concept Juvenile Dermatomyositis

Concept Acute Refusal to Walk

Concept Pediatric Differential Diagnosis

Concept Anti-MDA5 Antibody

Concept Early Diagnosis

Distinguished Non-Finalist

Presenter Organization Columbia University

Presenting Author Amy Lipman

Track Pediatric

Keywords

juvenile dermatomyositis

anti-MDA5 antibodies

refusal to walk

toddler myositis

atypical presentation

lower CK

MRI inflammatory changes

muscle biopsy

interstitial lung disease

pediatric inflammatory myopathy

Juvenile Dermatomyositis

Acute Refusal to Walk

Pediatric Differential Diagnosis

Anti-MDA5 Antibody

Early Diagnosis