A 4-year-old boy from Singapore, while on vacation in the United States (first to Georgia and then Washington, D.C.), was evaluated for a subacute progressive ascending weakness. Five days before, he had noted the onset of vague paresthesias and muscular pains beginning in the distal left leg and later in the distal right leg. There was a gradual progression of difficulties with walking during the next 5 days.Upon initial presentation, the patient was complaining of mostly lower extremity but also some upper extremity weakness and was unable to stand on his own. There were no problems with breathing, talking, or swallowing, and no complaints of back pain or difficulties with bowel or bladder function.
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