Acute disseminated encephalomyelitis after para-influenza infection post bone marrow transplantation

Acute disseminated encephalomyelitis (ADEM) is a parainfectious or postvaccination demyelinating condition, characterized by rapid onset of multifocal neurological deficits, usually occurring in childhood or adolescence. We report case of ADEM in an allogeneic bone marrow transplant recipient, who presented with rapid onset of paraplegia and widespread neurological deficits 6 weeks after parainfluenza pneumonia. Magnetic resonance imaging (MRI) showed typical features of ADEM, involving the subcortical white matter, brain steam and spinal cord. There was a rapid and complete response to pulse high-dose corticosteriod and intravenous immunoglobulin. The importance of recognition and early treatment of this rare condition in transplantation practice is emphasized.