Acute Disseminated Encephalomyelitis Developed after Mycoplasma Pneumoniae Infection Complicating Subclinical Measles Infection

Hagiwara, Hiroshi; Sakamoto, Shizuki; Katsumata, T; Katayama, Yasuo

doi:10.2169/internalmedicine.48.1740

Cited by 16 publications

(9 citation statements)

References 18 publications

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“…Measles virus has been loosely linked with both MS and ADEM [32,[89][90][91][92][93][94][95][96][97]. Hagiwara et al [91] report a case of ADEM following Mycoplasma pneumonia infection complicated with measles and comment on the potential involvement of multiple infectious agents in the pathogenesis of ADEM. VZV has been isolated in the CSF of MS patients and has also been identified during MS flares [98][99][100].…”

Section: Viruses Common In Adem and Msmentioning

confidence: 99%

Acute disseminated encephalomyelitis progressing to multiple sclerosis: Are infectious triggers involved?

et al. 2014

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Acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) are demyelinating disorders affecting the central nervous system. An autoimmune aetiology has been proposed for both. ADEM principally affects adolescents following acute infection by a variety of pathogens and has also been reported to occur following vaccination. ADEM typically resolves following medical treatment, whereas MS follows a more relapsing and remitting course. The pathogenesis of MS remains unclear, but it is thought that a combination of infectious and non-infectious environmental factors and host genetics act synergistically to cause disease. A variety of viruses, including Epstein Barr virus, cytomegalovirus, herpes simplex virus and varicella zoster virus, have been implicated as possible infectious triggers. The similar clinical and pathological presentation of ADEM and MS presents a diagnostic challenge for distinguishing ADEM from a first episode of MS. Some cases of ADEM progress to MS for reasons that are not currently clear. This review examines the evidence for infectious agents as triggers for ADEM progressing to MS and suggests potential methods that may facilitate identification of infectious agents that may be responsible for the pathogenesis of ADEM to MS.

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Section: Viruses Common In Adem and Msmentioning

confidence: 99%

Acute disseminated encephalomyelitis progressing to multiple sclerosis: Are infectious triggers involved?

et al. 2014

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“…[59][60][61][62][63][64][65][66][67][68][69][70] It has been proposed that the risk of ADEM is highest with measles and rubella, with the risk after infection with these viruses being 1:1000 and 1:20,000, respectively. 71 Other infectious agents that have been linked to ADEM include group A b-hemolytic streptococcal infection, 72,73 pertussis, 74 Mycoplasma pneumonia, 75,76 Borrelia burgdorferi, 77 Legionella, 75,78 Rickettsiae, 79 and Plasmodium falciparum and Plasmodium vivax malaria. 80 Approximately 5% to 12% of patients with ADEM have a history of vaccination within the month before presentation.…”

Section: Immunopathogenesismentioning

confidence: 99%

The Magnetic Resonance Imaging Appearance of Monophasic Acute Disseminated Encephalomyelitis

Marin

Callen

2013

Neuroimaging Clinics of North America

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Acute disseminated encephalomyelitis (ADEM) is an immunologically mediated inflammatory disease of the central nervous system that typically occurs after a viral infection or recent vaccination, and is most commonly seen in the pediatric population. In 2007 the International Pediatric Multiple Sclerosis Study Group proposed a consensus definition for ADEM for application in research and clinical settings. This article gives an overview of ADEM in children, focusing on differences that have emerged since the consensus definition was established. Although the focus is on neuroimaging in these patients, a synopsis of the clinical features, immunopathogenesis, treatment, and prognosis of ADEM is provided.

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“…No controlled clinical trials or recommendations are available for optimal management. The literature suggests benefits from immune-modulating therapy, with intravenous methylprednisolone (20-30 mg/kg/day, maximum 1gm/day) for 3-5 days, followed by tapered oral corticosteroids over 4-6 weeks [11,12]. Poor responders to pulse dose steroids are treated with IVIG at 2 g/kg divided over 2-5 days or undergo plasmapheresis.…”

Section: Discussionmentioning

confidence: 99%

A case of acute disseminated encephalomyelitis following Mycoplasma pneumoniae infection

Laila

El-Lababidi

Hisham

et al. 2018

IDCases

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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.

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Acute Disseminated Encephalomyelitis Developed after Mycoplasma Pneumoniae Infection Complicating Subclinical Measles Infection

Abstract: Abstract

Cited by 16 publications

References 18 publications

Acute disseminated encephalomyelitis progressing to multiple sclerosis: Are infectious triggers involved?

Acute disseminated encephalomyelitis progressing to multiple sclerosis: Are infectious triggers involved?

The Magnetic Resonance Imaging Appearance of Monophasic Acute Disseminated Encephalomyelitis

A case of acute disseminated encephalomyelitis following Mycoplasma pneumoniae infection

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