Pediatric patient with acute disseminated encephalomyelitis with MRI scans characteristic of multiple sclerosis

Address for correspondence: Joana Laurindo da Silva (email: [e-mail]).

Abstract

Case Presentation: A 6-year-old boy presented to the Emergency Room of a Hospital in the city of Florianópolis, Brazil, with behavioral arrest and staring eyes that lasted more than two hours and progressed with lowered level of consciousness. He was being treated for an upper-respiratory-tract infection with symptomatics. Antiepileptic drugs were administered, with resolution of the seizures. The brain magnetic resonance imaging (MRI) scan performed was compatible with acute disseminated encephalomyelitis (ADEM). He was treated with intravenous methylprednisolone, exhibiting great recovery. A control MRI scan after three months of the hospitalization showed many white matter lesions, some of them with enhancement, consistent with MS. The patient was asymptomatic during this period. The test for MOG autoantibody was negative. The boy was diagnosed with possible MS and started on interferon beta. After three years, he maintained an EDSS score of zero, although the MRI showed that he continued to accumulate new brain lesions. Therefore, when the boy becomes older, changing to a more effective drug is under consideration.

Discussion: Acute disseminated encephalomyelitis is a rare initial presentation of MS, especially if compared to other demyelinating diseases; therefore, it is important to exclude alternative diagnoses. In this case, the McDonald criteria should not be applied, and the child has not had other non-ADEM attacks to fulfill the criteria; nevertheless, he has juxtacortical, periventricular, and infratentorial lesions on MRI and, in follow-up images, shows enhancement of certain lesions. We decided to initiate treatment, despite fulfilling the diagnostic criteria for MS, since it is a highly-active disease with lesions that can result in disability in the future, even with no clinical relapse.

Final Comments: The present case report is a reminder that ADEM may be a first presentation of MS, and that it could be suspected mostly by MRI pattern.

 

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Publikationsverlauf

Artikel online veröffentlicht:
02. Oktober 2024