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Acute disseminated encephalomyelitis (ADEM)--a rare complication of falciparum malaria

Sarangi Rachita1, Mahapatra Satyasundar, Dash Mrutunjaya

  • 1Department of Pediatrics, Institute of Medical Sciences and SUM Hospital, Kalinga Nagar, Bhubaneswar, 751003 Odisha, India. rachitapaedia@gmail.com

Indian Journal of Pediatrics
|June 16, 2012
PubMed

Insights

A child with falciparum malaria developed acute disseminated encephalomyelitis (ADEM), a serious neurological complication. Prompt corticosteroid treatment led to remarkable recovery and complete resolution of brain lesions.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Pediatrics

Background:

  • Plasmodium falciparum malaria can present with severe neurological complications.
  • Acute disseminated encephalomyelitis (ADEM) is a rare but serious post-infectious inflammatory demyelinating disease.
  • Early recognition and management are crucial for favorable outcomes in pediatric neurological emergencies.

Observation:

  • A 4-year-old girl with Plasmodium falciparum malaria experienced neurological deterioration, presenting with fever, altered sensorium, coma, and decerebration.
  • Brain MRI revealed multifocal asymmetrical T2W/FLAIR hyperintensities in the cerebral hemispheres, subcortical white matter, and midbrain, consistent with demyelination.
  • No grey matter involvement was observed on MRI.

Findings:

  • The patient was diagnosed with acute disseminated encephalomyelitis (ADEM) secondary to falciparum malaria.
  • Treatment with methylprednisolone resulted in significant neurological improvement.
  • Follow-up MRI after one year demonstrated complete resolution of the demyelinating lesions.

Implications:

  • This case highlights the potential for ADEM as a complication of falciparum malaria in children.
  • The findings underscore the importance of neuroimaging and prompt corticosteroid therapy in managing severe neurological complications of malaria.
  • Successful treatment suggests that early intervention can lead to complete neurological recovery and radiological resolution.

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