A Case of Tuberculosis-Associated Acute Disseminated Encephalomyelitis in a Seven-Month-Old Infant
Jennifer H Yang1,2, Kim T Vuong3,4, Amaran Moodley5,6
1Pediatric Neurology, Rady Children's Hospital, San Diego, USA.
Insights
A seven-month-old infant with tuberculosis (TB) developed acute disseminated encephalomyelitis (ADEM), a rare immune-mediated condition. Prompt treatment with steroids and antitubercular medications led to significant motor function recovery.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Immunology
Background:
- Tuberculosis (TB) can present with diverse central nervous system (CNS) complications.
- Immune-mediated neurological syndromes are recognized, but their association with pediatric TB requires further elucidation.
Observation:
- A previously healthy seven-month-old infant presented with acute encephalopathy and focal weakness.
- Neuroimaging revealed findings consistent with acute disseminated encephalomyelitis (ADEM) in the brain and spinal cord.
- Cerebrospinal fluid analysis did not confirm active TB infection.
Findings:
- The infant was diagnosed with pulmonary TB and ADEM.
- Treatment involved high-dose steroids and antitubercular medications.
- Remarkable recovery of gross motor function was observed following treatment.
Implications:
- This case highlights a potential, previously unreported association between TB and immune-mediated demyelinating syndromes in children.
- This presentation appears clinically distinct from other known CNS complications of TB.
- Further research is warranted to understand the immunopathogenesis and clinical spectrum of TB-associated neurological disorders in pediatric populations.
Abstract:
A seven-month-old previously healthy female infant presented with acute onset encephalopathy and left focal weakness in the setting of three months of non-productive cough. She was diagnosed with pulmonary tuberculosis (TB), and neuroimaging showed multifocal non-enhancing T2 hyperintensities in the brain and longitudinal T2 hyperintensity in the spinal cord consistent with acute disseminated encephalomyelitis (ADEM). However, her cerebrospinal fluid (CSF) did not show evidence of TB infection. She was treated with high-dose steroids for five days with a steroid taper along with antitubercular medications with a remarkable recovery in gross motor function. This case suggests a previously unreported association between TB and an immune-mediated demyelinating syndrome in children that is clinically distinct from other more common forms of TB-associated central nervous system (CNS) complications.
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