Acute disseminated encephalitis in a pediatric patient: case report

Abstract

Introduction: Acute disseminated encephalomyelitis (ADEM) is an acute demyelinating disease of the central nervous system, typically associated with viral infection or immunization. It manifests with acute encephalopathy and multifocal neurological symptoms. Presentation of the Case: The patient, a female schoolgirl with no significant medical history or evidence of prior immunization, presented with intolerance to oral intake, drowsiness, seizures, and behavioral changes. She was admitted to the emergency department with a deteriorating level of consciousness, necessitating
advanced management. Clinical evaluation by the neurology department prompted an MRI, revealing multiple hyperintense lesions with involvement of the round white matter and well-defined borders. Steroid therapy was initiated due to the clinical presentation and evolution. In the absence of clinical response, intravenous immunoglobulin was administered, leading to gradual recovery of the motor symptoms. The patient was subsequently discharged for outpatient follow-up with the neurology service. Conclusion: ADEM poses a diagnostic challenge in the early stages of symptoms.
Undiagnosed or inadequately treated cases carry a higher risk of devastating sequelae, though the neurocognitive prognosis is generally favorable. Therefore, ADEM should always be considered in  the differential diagnoses of patients presenting with central nervous system pathology, particularly those with a recent history of immunization or infections.