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[Acute disseminated encephalomyelitis presenting as an acute urinary febrile retention]
J Guison1, M Groza1, O Stoica1
1Service de médecine interne et maladies infectieuses, hôpital Pasteur, hôpitaux civils de Colmar, 39, avenue de la Liberté, 68024 Colmar, France.
Introduction:
MRI should be performed in the presence of an acute febrile urinary retention, when septic and obstructive causes are eliminated. We report a case of post-infectious probable acute disseminated encephalomyelitis (ADEM) with a mostly spinal cord tropism of involving Campylobacter.
Case Report:
A 32-year-old man with no medical history was admitted for an acute febrile urinary retention. He reported severe diarrhea 3 days before. Clinical course was then complicated by a progressive tetraparesis predominating in the lower limbs. Medullar MRI showed thoracic myelitis. A five-day course of intravenous corticosteroids allowed a full recovery of both the motor and urinary symptoms. Fecal culture isolated Campylobacter sp. Final diagnosis was post-bacterial ADEM.
Conclusion:
Clinical findings and MRI allow clinicians to suspect acute disseminated encephalomyelitis. This hypothesis implies to actively look for recent infections or vaccinations preceding the clinical presentation.
Insights
Acute disseminated encephalomyelitis (ADEM) can follow Campylobacter infections, presenting with spinal cord inflammation and urinary retention. Prompt MRI and corticosteroid treatment led to full recovery in a patient with post-bacterial ADEM.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Acute febrile urinary retention necessitates MRI to rule out septic and obstructive causes.
- Post-infectious neurological syndromes, such as acute disseminated encephalomyelitis (ADEM), can present atypically.
Observation:
- A 32-year-old male presented with acute febrile urinary retention and progressive tetraparesis following Campylobacter-induced diarrhea.
- Thoracic myelitis was identified on magnetic resonance imaging (MRI).
Findings:
- The patient experienced a full motor and urinary symptom recovery after a five-day course of intravenous corticosteroids.
- Campylobacter species were isolated from fecal cultures, confirming a post-bacterial etiology for ADEM.
Implications:
- Clinical presentation and MRI findings are crucial for suspecting ADEM.
- Identifying preceding infections or vaccinations is essential for diagnosing ADEM and guiding treatment.
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