An infant with steroid-refractory cytomegalovirus-associated ADEM who responded to immunoglobulin therapy

Acute disseminated encephalomyelitis (ADEM) develops via an immunological mechanism. We encountered a 10-month-old infant with a rare pathogenesis of cytomegalovirus (CMV)-related ADEM. The patients complaints were; protracted fever; consciousness disorder; and affected cervical stability. Cerebral magnetic resonance imaging (MRI) 9 days after onset, revealed a disseminated lesion, suggesting ADEM. Pulse therapy with methylprednisolone at 30 mg/kg was performed for 3 days. However, its clinical efficacy was not marked. Therapy with immunoglobulin (IVIg) at 400 mg/kg/day was started 15 days after onset, and continued for 5 days. This markedly improved the consciousness level and muscle strength, and the infant was discharged without neurological sequelae. ADEM showed a monophasic course, and the infant's subsequent growth has been favorable. Altough the number of case reports is small, massive-IVIg therapy should be considered in patients with steroid-refractory ADEM, as demonstrated in this case study.