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Acute disseminated encephalomyelitis due to Rickettsia conorii infection

D Woolf1, M Jordaan, G Maartens

  • 1Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa. docdwoolf@icloud.com.

South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde
|May 4, 2021
PubMed

Insights

Acute disseminated encephalomyelitis (ADEM) can rarely occur after delayed diagnosis of Rickettsia conorii infection, a type of Mediterranean spotted fever. Early treatment with antibiotics and corticosteroids improved patient outcomes.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Immunology

Background:

  • Acute disseminated encephalomyelitis (ADEM) is an immune-mediated inflammatory demyelinating disorder.
  • ADEM typically follows viral infections or immunizations.
  • Rickettsial infections, like Rickettsia conorii, are known causes of fever and rash.

Observation:

  • A man with Rickettsia conorii infection presented with delayed diagnosis, exhibiting fever, headache, an eschar, and acute paraplegia.
  • Magnetic resonance imaging revealed multifocal brain and spinal cord lesions indicative of inflammatory demyelination.
  • The patient's R. conorii IgM serum titre was elevated at 1:128.

Findings:

  • This case represents the first documented instance of ADEM associated with Mediterranean spotted fever (Rickettsia conorii).
  • The patient demonstrated a positive response to doxycycline and high-dose corticosteroids.
  • A previous report linked ADEM to Rocky Mountain spotted fever in a child with delayed diagnosis.

Implications:

  • Delayed diagnosis of spotted fever group rickettsial infections may be a rare trigger for ADEM.
  • This finding expands the known neurological complications associated with rickettsial diseases.
  • Prompt diagnosis and treatment of rickettsial infections are crucial to prevent severe neurological sequelae like ADEM.

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