A case of acute disseminated encephalomyelitis following Mycoplasma pneumoniae infection

Abstract

We report a case of acute disseminated encephalomyelitis (ADEM) secondary to Mycoplasma pneumoniae infection that failed to improve with methylprednisolone and intravenous immunoglobulin (IVIG); who responded with plasmapheresis. A 21- year- old female with an unremarkable medical history, initially presented to an outside hospital with fever and an influenza-like illness and was subsequently intubated for worsening sensorium. Brain magnetic resonance imaging was suggestive of ADEM or vasculitis for which she received five days of pulse steroids and IVIG. She showed no signs of improvement and was transferred to our hospital for plasmapheresis. Her work up revealed an elevated IgM antibody and positive sputum for Mycoplasma pneumonia by polymerase chain reaction, suggesting the pathogen as the culprit for her ADEM. Intravenous azithromycin and daily plasmapheresis were initiated for seven consecutive days. Following commencement of her treatment, the patient experienced good recovery and was subsequently extubated. She continued to improve with physical therapy and gained mobility, with the help of a walker. Patients commonly present with ADEM following viral infection or vaccination and less frequently post bacterial infection. The current treatment of ADEM due to Mycoplasma pneumoniae is based on limited case reports. Our patient poorly responded to pulse steroids and IVIG, while she markedly improved on azithromycin and plasmapheresis. In patients presenting with encephalopathic signs and neurological manifestations following pneumonia; Mycoplasma pneumoniae infection and subsequent immune-mediated demyelination should be considered.

Efficacy of levofloxacin on macrolide-unresponsive and corticosteroid-resistant refractory Mycoplasma pneumoniae pneumonia in children

“…It should be in the differential diagnosis whenever respiratory symptoms are followed by neurological manifestations and encephalopathic signs (24). Brain MRI is extremely useful to establish a diagnosis of ADEM; with better visualization of the demyelinating lesions (25). In this study, one patient developed ADEM with abnormal brain MRI and occurred serious sequelae.…”

A rare case of bilateral optic neuritis and acute disseminated encephalomyelitis post mycoplasma pneumoniae infection

“…2,3 There are few reports worldwide in the English literature of ADEM due to M pneumoniae infection; 19 including a report in a young adult from UAE. 20 Al-Zaidy Sa, et al 21 reported ADEM in 12% of those patients whom had neurologic disease attributable to M pneumoniae infection. 21 The underlying mechanism for the CNS complications include either direct invasion into the CSF or a systemic immune-mediated response provoked by molecular mimicry 2 to 3 weeks after the respiratory disease subsided.…”

Case of Acute Disseminated Encephalomyelitis Associated with Cytomegalovirus Reactivation in an Immunocompromised Systemic Lupus Erythematosus Patient

“…Only a few described cases have been associated with CMV and none of them, to the best of our knowledge, in an immunocompromised patient. ADEM associated with systemic lupus erythematosus (SLE) has rarely been reported [2][3][4][5].…”