Acute disseminated encephalomyelitis in a pediatric patient: case report

*Correspondence: [e-mail].

Abstract

Case Presentation: This is an 8-year-old female child from Catu (BA). She presented symptoms that started in January/2023 of vomiting, myalgia and vertigo, evolving a few days later with fever, drowsiness and nystagmus. She presented with pharyngotonsillitis prior to the beginning of the reported symptoms. Due to suspicion of meningoencephalitis, antibiotic therapy (ceftriaxone) and antiviral therapy (acyclovir) was started and cerebrospinal fluid collection was performed, which was normal. Among the serologies collected, serology for cytomegalovirus (CMV) IgG reagent was evidenced. Magnetic resonance imaging (MRI) of the skull with alterations suggestive of acute disseminated encephalomyelitis (ADEM). Pulse therapy with methylprednisolone was performed for 3 days, with significant improvement of the condition and oral corticosteroids were maintained for 6 weeks, with good response. Currently, the patient has no complaints and a normal neurological examination.

Discussion: ADEM is an acute, inflammatory and demyelinating disease of the central nervous system (CNS) with multifocal involvement, affecting the cerebral white matter and spinal cord. It has a rare incidence, with an expected rate for the pediatric age group. It is an autoimmune disease whose pathogenesis is still not fully understood. Clinical manifestations may arise after infections, either by viral agents, by bacteria, after vaccination or after the use of medications.

Final Comments: Thus, the importance of ADEM as a differential diagnosis in pediatric neurology in patients with acute, progressive and severe symptoms is verified. This condition, when diagnosed early, has a better response to treatment and a better prognosis.

 

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Publication History

Article published online:
12 May 2025