ILLUSTRATIVE CASE
Acute Disseminated Encephalomyelitis Following Meningoencephalitis Case Report and Literature Review Matthew D. Elias, MD,* Sona Narula, MD,Þ and Andrew S. Chu, MD*
Abstract: Meningoencephalitis and acute disseminated encephalomyelitis (ADEM) are both neurological disease processes, but there have been few cases of meningoencephalitis progressing to ADEM in the pediatric population. A case of a 4-year-old girl with an initial diagnosis of meningoencephalitis is presented here, whose initial presentation was manifested by prolonged fever, gray matter signal abnormality on brain magnetic resonance imaging, cerebrospinal fluid pleocytosis, and a markedly irritable mental status. As her neurological examination changed with focal abnormalities, a repeat magnetic resonance imaging demonstrated new areas of both gray and white matter signal abnormality, consistent with ADEM. Her symptoms and imaging findings completely resolved with a course of methylprednisolone. Based on the literature and this current case, it is our recommendation to consider ADEM as a diagnosis if meningoencephalitis is not improving. Key Words: meningoencephalitis, encephalitis, acute disseminated encephalomyelitis (Pediatr Emer Care 2014;30: 254Y256)
A
cute disseminated encephalomyelitis (ADEM) is typically a monophasic, demyelinating disease of the central nervous system (CNS). It is most often described as a postinfectious process, likely mediated by an immune-mediated response in the CNS. Few reports though have documented meningoencephalitis as the etiology for ADEM. We describe the case of a 4-year-old girl who developed ADEM after meningoencephalitis.
CASE A 4-year-old girl with no significant medical history presented with a 2-week history of fever, emesis, mild headaches, and diffuse abdominal pain. During this time, she visited her pediatrician several times and had two local emergency department (ED) visits, and she was treated twice for streptococcal pharyngitis with amoxicillin and then intramuscular penicillin. She did not report rhinorrhea, congestion, sore throat, diarrhea, rash, photophobia, or ataxia. With worsening fatigue and ongoing symptoms, she presented to our ED. Before this presentation, she was otherwise healthy. She was born full term and had no prior hospitalizations or surgeries. Her immunizations were up-to-date, and she had a normal development. Her family history was significant for multiple sclerosis in her maternal grandfather. In her hometown, she had exposures to ticks and a petting zoo. From the Divisions of *General Pediatrics and †Neurology, The Children’s Hospital of Philadelphia, Philadelphia, PA. Disclosure: The authors declare no conflict of interest. Reprints: Matthew D. Elias, MD, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Blvd, Pediatric Residency Program, Suite 9NW55, Philadelphia, PA 19104 (e
Acute Disseminated Encephalomyelitis Following Meningoencephalitis Case Report and Literature Review Matthew D. Elias, MD,* Sona Narula, MD,Þ and Andrew S. Chu, MD*
Abstract: Meningoencephalitis and acute disseminated encephalomyelitis (ADEM) are both neurological disease processes, but there have been few cases of meningoencephalitis progressing to ADEM in the pediatric population. A case of a 4-year-old girl with an initial diagnosis of meningoencephalitis is presented here, whose initial presentation was manifested by prolonged fever, gray matter signal abnormality on brain magnetic resonance imaging, cerebrospinal fluid pleocytosis, and a markedly irritable mental status. As her neurological examination changed with focal abnormalities, a repeat magnetic resonance imaging demonstrated new areas of both gray and white matter signal abnormality, consistent with ADEM. Her symptoms and imaging findings completely resolved with a course of methylprednisolone. Based on the literature and this current case, it is our recommendation to consider ADEM as a diagnosis if meningoencephalitis is not improving. Key Words: meningoencephalitis, encephalitis, acute disseminated encephalomyelitis (Pediatr Emer Care 2014;30: 254Y256)
A
cute disseminated encephalomyelitis (ADEM) is typically a monophasic, demyelinating disease of the central nervous system (CNS). It is most often described as a postinfectious process, likely mediated by an immune-mediated response in the CNS. Few reports though have documented meningoencephalitis as the etiology for ADEM. We describe the case of a 4-year-old girl who developed ADEM after meningoencephalitis.
CASE A 4-year-old girl with no significant medical history presented with a 2-week history of fever, emesis, mild headaches, and diffuse abdominal pain. During this time, she visited her pediatrician several times and had two local emergency department (ED) visits, and she was treated twice for streptococcal pharyngitis with amoxicillin and then intramuscular penicillin. She did not report rhinorrhea, congestion, sore throat, diarrhea, rash, photophobia, or ataxia. With worsening fatigue and ongoing symptoms, she presented to our ED. Before this presentation, she was otherwise healthy. She was born full term and had no prior hospitalizations or surgeries. Her immunizations were up-to-date, and she had a normal development. Her family history was significant for multiple sclerosis in her maternal grandfather. In her hometown, she had exposures to ticks and a petting zoo. From the Divisions of *General Pediatrics and †Neurology, The Children’s Hospital of Philadelphia, Philadelphia, PA. Disclosure: The authors declare no conflict of interest. Reprints: Matthew D. Elias, MD, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Blvd, Pediatric Residency Program, Suite 9NW55, Philadelphia, PA 19104 (e
