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Published on: April 28, 2019
Acute disseminated encephalomyelitis due to a zoonotic co-infection
Anam Siddiqui1, Shivani Randev1, Nidhi Singla2
1Department of Pediatrics, Government Medical College and Hospital, Chandigarh 160030, India.
Abstract:
Acute disseminated encephalomyelitis (ADEM) is a post-infectious, autoimmune, demyelinating neurological illness, usually attributed to infection with viruses. We describe a case of ADEM occurring in a child with Leptospira-Brucella co-infection. The 12-year-old girl developed a biphasic febrile illness with encephalopathy. On evaluation, she was found to have serological evidence of Brucella and Leptospira infections. Persistence of neurological symptoms after initiating treatment for the co-infection led us to do a magnetic resonance imaging scan of the brain which showed typical findings suggestive of ADEM. Patient responded appropriately to treatment of ADEM with glucocorticoids. The high prevalence of these zoonotic infections in developing countries, and the risk that these may lead to ADEM highlights the importance of detailed evaluation of such cases for proper treatment and better outcomes.
Insights
Acute disseminated encephalomyelitis (ADEM) can occur after infections. This case highlights ADEM in a child with co-infection of Leptospira and Brucella, emphasizing thorough evaluation for zoonotic diseases.
Area of Science:
- Neurology
- Infectious Diseases
- Autoimmune Disorders
Background:
- Acute disseminated encephalomyelitis (ADEM) is a rare neurological condition often following viral infections.
- Zoonotic infections, such as Leptospira and Brucella, are prevalent in developing regions.
Observation:
- A 12-year-old girl presented with a biphasic febrile illness and encephalopathy.
- Serological tests confirmed co-infection with Leptospira and Brucella.
- Neurological symptoms persisted despite initial treatment for the co-infection.
Findings:
- Brain MRI revealed findings characteristic of ADEM.
- The patient showed a positive response to glucocorticoid therapy for ADEM.
Implications:
- This case underscores the potential for Leptospira-Brucella co-infection to trigger ADEM.
- Early and comprehensive diagnostic evaluation is crucial for managing ADEM in endemic areas.
- Recognizing zoonotic origins of ADEM can improve patient outcomes.
