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Acute disseminated encephalomyelitis following Pontiac fever
S Spieker1, D Petersen, A Rolfs
1Department of Neurology,University of Tübingen, Germany. sybille.spieker@uni-tuebingen.de
Abstract:
We report the case of a 35-year-old woman who developed headache and psychosis and gradually became comatose within 3 weeks after a flu-like infection. MRI revealed bifrontal demyelination consistent with acute disseminating encephalomyelitis (ADEM). Two different cerebrospinal fluid samples were positively tested for Legionella cincinnatiensis by direct sequencing of a PCR-amplified Legionella-specific fragment. This result made it possible to interpret the initial symptoms as Pontiac fever. We think it most likely that this is a case of ADEM following the very rare situation of a systemic infection with L. cincinnatiensis. A review of the literature on Legionella-associated encephalopathy suggests that some of these cases may also have had ADEM.
Insights
A rare case of acute disseminated encephalomyelitis (ADEM) was linked to Legionella cincinnatiensis infection. This rare bacterial infection may cause neurological symptoms and ADEM, a serious brain condition.
Area of Science:
- Neurology
- Infectious Diseases
- Microbiology
Background:
- Acute disseminated encephalomyelitis (ADEM) is an autoimmune disorder characterized by widespread inflammation and demyelination in the central nervous system.
- Legionella species are known to cause pneumonia and Pontiac fever, a mild flu-like illness, but neurological complications are rare.
Observation:
- A 35-year-old woman presented with headache, psychosis, and coma developing over 3 weeks following a flu-like illness.
- Brain MRI revealed bifrontal demyelination, consistent with ADEM.
- Cerebrospinal fluid samples tested positive for Legionella cincinnatiensis via PCR sequencing.
Findings:
- The patient's symptoms were attributed to ADEM triggered by a systemic Legionella cincinnatiensis infection, presenting initially as Pontiac fever.
- This case represents a rare instance of ADEM following infection with L. cincinnatiensis.
Implications:
- This case highlights a potential, albeit rare, neurological complication of Legionella infection, specifically ADEM.
- Further research into Legionella-associated encephalopathy may reveal more cases with underlying ADEM, expanding our understanding of neuroinfectious diseases.