acute flaccid paralysis ( afp ) is a clinical entity characterized by areflexia and/or hyporeflexia and weakness which reaches a maximum within days or weeks .
polioviruses , enterovirus 71 , flavivirus , herpes virus , and rabies virus are well - known as viral etiologic agents . in this article , who presented with lower respiratory tract infection and afp , and
was detected to have co - infection of human coronavirus ( hcov ) 229e and oc43 is reported .
afp associated with hcov infections has not been reported previously in the literature , and has been reported for the first time in this article .
a 3-year - old girl hospitalized due to the development of shortness of breath and inability to walk 1-day after the beginning of fever , rhinorrhea , cough , and weakness . on the same day , respiratory distress increased , she was intubated , and mechanical ventilation started .
on physical examination , she was conscious but swallowing , chewing and speech functions damaged , muscle strength was 0/5 and deep tendon reflexes ( dtrs ) were absent , the plantar response was flexor .
complete blood count , electrolytes and blood biochemistry and urinalysis were normal , c - reactive protein was negative and erythrocyte sedimentation rate was 20 mm / h .
no abnormalities in the brain and spinal cord magnetic resonance imaging were detected - so intracranial and spinal pathologies were excluded .
after 48 h of hospitalization , a total of 2 g / kg intravenous immunoglobulin ( ivig ) in 3 days was given .
muscle strength improved to 23/5 , dtr became norm active , bulbar paralysis and respiratory distress had regressed . at the end of the 2 week , she could mobilize and walk with a guide .
lumbar puncture and enmg repeated in the 3 week did not reveal any pathological findings and gullian  barre syndrome ( gbs ) was completely excluded .
real - time polymerase chain reaction ( pcr ) analysis of nasal swab samples was reported to be positive for hcov 229e and oc43 and hcov co - infection was diagnosed .
flaccid paralysis occurs by the damage of lower motor neurons in the anterior horn of the spinal cord or peripheral nerves either by direct invasion or parainfectious and/or postinfectious immune - mediated mechanisms . besides gbs ,
differential diagnosis of afp includes : compressive and inflammatory diseases of spinal cord , the anterior horn motor neurons involvement by infectious ( poliomyelitis vaccine - associated poliomyelitis , other enteroviral myelitis , a japanese encephalitis , and west nile virus as agents ) and vascular pathology , myasthenia gravis , drug and toxins affecting neuromuscular junction ( aminoglycosides , organophosphates , snake venom and botulism , etc . ) , muscle disease such as viral myositis or inflammatory myopathy , hypokalemic periodic paralysis and electrolyte disorders ( hypermagnesemia and hypokalemia ) .
preliminary diagnosis was gbs for this case ; however , csf and enmg findings in the 1 week of paralysis did not support this diagnosis . during the period of mechanical ventilation muscle strength increased and in this short time dtr normalized , as well as after 3 weeks paralysis started no pathologic findings observed by repeating lumbar puncture and enmg so gbs was excluded .
history , clinical presentation , physical examination , and laboratory tests were totally normal that ruled out toxicological etiology , polio , and botulismus .
members of coronaviridae can cause respiratory , intestinal , hepatic and neurological diseases of various severities in humans and animals .
hcovs can cause neurological symptoms such as seizures and meningoencephalitis in children but afp has not been reported until now .
hcovs may cause more serious respiratory disease in case of immune suppression and with various respiratory agents rather than single infection .
in addition hcov , 229 and oc43 co - infection causing more severe respiratory disease has been demonstrated by a study .
we have reported case of co - infection with hcov 229e and oc43 detected by real - time pcr analysis of nasal swab samples , and additional different respiratory pathogen has not been demonstrated , it suggests that co - infection caused lower respiratory tract infection and afp .
we believe that hcov 229e and oc43 co - infection may cause respiratory failure and afp .
whether ivig have a role in the treatment needs to be supported by more data from the literature .
 acute flaccid paralysis ( afp ) is a life - threatening clinical entity characterized by weakness in the whole body muscles often accompanied by respiratory and bulbar paralysis . 
 the most common cause is gullian  barre syndrome , but infections , spinal cord diseases , neuromuscular diseases such as myasthenia gravis , drugs and toxins , periodic hypokalemic paralysis , electrolyte disturbances , and botulism should be considered as in the differential diagnosis . 
 human coronaviruses ( hcovs ) cause common cold , upper and lower respiratory tract disease , but in the literature presentation with the lower respiratory tract infection and afp has not been reported previously . in this study , 
 pediatric case admitted with lower respiratory tract infection and afp , who detected for hcov 229e and oc43 co - infection by the real - time polymerase chain reaction , has been reported for the first time . 
Introduction
Case Report
Discussion
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