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Acute disseminated encephalomyelitis associated with Mycoplasma pneumoniae infection
K Yamamoto1, M Takayanagi, Y Yoshihara
1Department of Pediatrics, Sendai City Hospital, Japan.
Abstract:
An 8 year old girl with acute disseminated encephalomyelitis (ADEM) is described. Elevated serum antibody titers suggested recent Mycoplasma pneumoniae infection. T2-weighted image of magnetic resonance imaging (MRI) disclosed multiple lesions of high signal intensity in bilateral basal ganglia and thalami as well as in the white matter. Postcontrast T1-weighted image revealed an enhanced lesion in the deep white matter. She showed rapid clinical improvement in response to corticosteroid therapy. The lesions had disappeared completely on MRI performed 10 weeks after the onset. ADEM is believed to be a demyelinating disorder of probable autoimmune etiology. MRI findings in this case may support the hypothesis that the primary pathological event is vascular injury and demyelination occurs only as a secondary phenomenon.
Insights
Acute disseminated encephalomyelitis (ADEM) in an 8-year-old girl, potentially triggered by Mycoplasma pneumoniae, showed rapid improvement with corticosteroid therapy. MRI scans confirmed lesion resolution, supporting vascular injury as a primary event in ADEM.
Area of Science:
- Neurology
- Immunology
- Infectious Diseases
Background:
- Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system.
- The etiology of ADEM is often post-infectious or post-vaccinal, with autoimmune mechanisms suspected.
- Mycoplasma pneumoniae infection is a recognized trigger for ADEM.
Observation:
- An 8-year-old girl presented with symptoms consistent with ADEM.
- Serum antibody titers indicated a recent Mycoplasma pneumoniae infection.
- Magnetic resonance imaging (MRI) revealed multiple high-signal intensity lesions in the basal ganglia, thalami, and white matter on T2-weighted images.
- A postcontrast T1-weighted image showed an enhanced lesion in the deep white matter.
Findings:
- The patient experienced rapid clinical improvement following corticosteroid treatment.
- Follow-up MRI scans at 10 weeks demonstrated complete resolution of the lesions.
- These MRI findings may suggest that vascular injury is the primary pathological event in this case of ADEM, with demyelination occurring secondarily.
Implications:
- This case highlights the potential role of Mycoplasma pneumoniae in ADEM pathogenesis.
- The observed MRI findings and rapid response to corticosteroids offer insights into ADEM's pathophysiology.
- The findings support the hypothesis of vascular injury preceding demyelination in certain ADEM cases.