An interesting case of acute disseminated encephalomyelitis following E. coli infection

Abstract

Acute disseminated encephalomyelitis (ADEM) is a rare inflammatory demyelinating disease of central nervous system (CNS), characterized by multifocal white matter involvement with neurological deficits and accompanied by encephalopathy. ADEM is thought to be caused by autoimmune etiology. CNS autoantigens are produced by molecular mimicry triggered by an environmental stimulus, mostly infection (viral/bacterial) or post vaccination, in genetically susceptible individuals. ADEM is sometimes referred to as post/para-infectious or post-immunization ADEM. ADEM is characterized by multifocal neurological signs and occasionally it rapidly progresses to coma. Magnetic resonance imaging (MRI) is used to confirm the diagnosis. The treatment is based on intravenous high-dose methylprednisolone, which usually leads to a rapid improvement. Recently, the use of intravenous immunoglobulins and plasma exchange (PLEX) has also been suggested. We report a case of a 6-year-old girl who was admitted for urinary tract infection but developed neurological complications which was treated successfully.

A Case of Post-Infective Myelin-Oligodendrocyte Glycoprotein Antibody-Associated Disease

“…10 Among post-infective CNS diseases, ADEM usually develops following an acute viral etiology, especially exanthematous disease, bacterial infection, or vaccination but rarely after immune sera. 11 There are two proposed explanations for the development of ADEM. The first is the inflammatory cascade concept, which involves direct invasion of the neurotropic pathogens into the CNS.…”

“…The second is molecular mimicry between the pathogen and myelin proteins of the host. 11 Therefore, in patients with inflammatory demyelinating lesions of the CNS after a preceding infection, differentiation between ADEM and MOGAD is often challenging to diagnose, and the pathogenesis of CNS demyelination induced by infection remains unclear.…”

Before attributing encephalomyelitis to SARS‐CoV‐2 vaccinations thoroughly exclude differentials

“…We do not agree that ADEM may be only due to viral infections or vaccinations. 1 ADEM has been also reported following radio‐chemotherapy, 2 bacterial infections with E. coli , 3 synthetic cannabinoids, 4 viper venoms, 5 herbal extracts, 6 hyponatriemia, or genetic disease, such as X‐lined Charcot Marie Tooth disease due to GJB1 mutations. 7 …”