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Acute Disseminated Encephalomyelitis with Seizures and Myocarditis: A Fatal Triad
- Source :
- Medicina, Medicina, Vol 56, Iss 277, p 277 (2020)
- Publication Year :
- 2020
- Publisher :
- MDPI, 2020.
-
Abstract
- Autoimmune pathology of acute disseminated encephalomyelitis (ADEM) is generally restricted to the brain. Our objective is to expand the phenotype of ADEM. A four-year-old girl was admitted to the pediatric emergency room of a university medical center five days after a common upper respiratory tract infection. Acute symptoms were fever, leg pain, and headaches. She developed meningeal signs, and her level of consciousness dropped rapidly. Epileptic seizure activity started, and she became comatose, requiring intubation and mechanical ventilation. Serial brain magnetic resonance imaging (MRI) illustrated the fulminant development of ADEM. Treatment escalation with high-dose corticosteroids, immunoglobulins, and plasma exchange did not lead to clinical improvement. On day ten, the patient developed treatment-refractory cardiogenic shock and passed away. The postmortem assessment confirmed ADEM and revealed acute lymphocytic myocarditis, likely explaining the acute cardiac failure. Human metapneumovirus and picornavirus were detected in the tracheal secrete by PCR. Data sources–medical chart of the patient. This case is consistent with evidence from experimental findings of an association of ADEM with myocarditis as a postinfectious systemic autoimmune response, with life-threatening involvement of the brain and heart.
- Subjects :
- Pediatrics
medicine.medical_specialty
Myocarditis
Fulminant
Case Report
030204 cardiovascular system & hematology
03 medical and health sciences
0302 clinical medicine
delirium
Human metapneumovirus
Medicine
critical illness
lcsh:R5-920
critical ill patient
biology
business.industry
ADEM
Cardiogenic shock
General Medicine
medicine.disease
biology.organism_classification
3. Good health
Upper respiratory tract infection
Acute disseminated encephalomyelitis
Epileptic seizure
Headaches
medicine.symptom
lcsh:Medicine (General)
business
030217 neurology & neurosurgery
Subjects
Details
- Language :
- English
- ISSN :
- 16489144 and 1010660X
- Volume :
- 56
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Medicina
- Accession number :
- edsair.doi.dedup.....7e839920efeb4abaaf09f5fb7af32832