A child with difficulty swallowing

Area of Science:

• Pediatric Neurology
• Infectious Diseases
• Demyelinating Diseases

Background:

• Difficulty swallowing (dysphagia) is a frequent emergency department complaint in children.
• Acute disseminated encephalomyelitis (ADEM) is a rare, immune-mediated demyelinating disorder.
• ADEM typically follows an infection or vaccination, presenting with encephalopathy and neurological deficits.

Observation:

• A male child presented with dysphagia as the initial symptom.
• Standard evaluations for common causes of dysphagia were inconclusive.
• The child was subsequently diagnosed with ADEM.

Findings:

• This case illustrates dysphagia as an unusual early presentation of ADEM.
• ADEM is characterized by widespread inflammation and demyelination in the central nervous system.
• Neurologic manifestations of ADEM are typically multifocal and acute or subacute.

Implications:

• Pediatricians and emergency physicians should consider ADEM in children with unexplained dysphagia.
• Early recognition of ADEM is crucial for timely intervention and management.
• This case underscores the importance of considering less common diagnoses for persistent, unexplained symptoms.