Inflammatory bowel disease and acute disseminated encephalomyelitis (ADEM): extraintestinal manifestation with typical changes in the central nervous system

*Correspondence: [e-mail].

Abstract

Case Presentation: Girl, 11 years old, previously healthy, observed abdominal pain, weight loss, nausea and vomit. During in-hospital investigation, she was diagnosed with inflammatory bowel disease, specifically Crohn's disease. In this same hospitalization, she experienced severe and progressive headache persistent for fifteen days, evolved with ataxia and dysarthria lasting forty-eight hours, with rapid improvement after use of corticosteroids to treat the gastrointestinal pathology. Cerebrospinal fluid puncture was performed without alterations, although magnetic resonance imaging of the brain evidenced areas of hypersignal alteration affecting white matter, with cerebellar and cerebral cortical involvement, justifying neurological findings.

Discussion: Inflammatory bowel diseases are chronic inflammatory condition that affects the digestive system and evolves in different ways through the gastrointestinal mucosa. Crohn's disease is characterized by ulcers that can involve transmurally any segment of the digestive tract, from mouth to anus. Besides gastrointestinal involvement, extraintestinal manifestations are common complaints of some patients, mouth, eyes, skin or the central and nervous system can be affected. Neurological involvement appears to occur rarely, however prevalence and incidence data are not available due to, because systematic studies are lacking. Demyelinating disorders are known to be related with inflammatory bowel diseases, as a disease association, similar behavior (disease like) or triggered by drug therapy. Manifestations as headache, paresthesia, dysarthria or aphasia, hyperreflexia are some of the referred complaints. In addition to symptomatology compatible with demyelination, the imaging findings corroborate the involvement of the central nervous system. In this case report, gastrointestinal and neurological manifestations were observed during diagnostic investigation, favoring clinical correlation. In addition, image particularities approximate the diagnosis for ADEM or ADEM like, after targeted therapy beginning, which seems to be more usual.

Final Comments: Considering the scarcity of specific data on neurological disorders associated with inflammatory bowel diseases, the reported case corroborates such evidence and reiterates the relevance of care shared between neurology and gastroenterology to establish the best therapeutic choice in these cases.

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Artikel online veröffentlicht:
12. Mai 2025