ACUTE DISSEMINATED ENCEPHALOMYELITIS – HERPES VIRUS 6 POST -INFECTION
Keywords:Acute disseminated encephalomyelitis, arreflexic flaccid paraplegia, herpesvirus 6
Background: Acute disseminated encephalomyelitis (ADEM) is a monophasic immune -mediated demyelinating disease of the central nervous system. The initial clinical presentation may be nonspecific, but is the result of involvement of different areas in white matter tracts of CNS and brain and spinal magnetic resonance imaging (MRI) is the gold standard complementary investigation for the diagnosis.
Case report: A 16 month-old child, hospitalized for loss of walking ability of acute onset, irritability and refusal to eat. The neurological examination revealed: irritability alternating with periods of drowsiness, arreflexic flaccid paraplegia and trunkal ataxia, and urinary retention. Examination of cerebrospinal fluid showed lymphocytic pleocytosis, and herpes virus 6 were isolated by Polymerase Chain Reaction technic. The MRI revealed T2-weight hyperintense diffuse signal in D2-D3 and from D6 to the medullary connus also. She started therapy with steroids and human immunoglobulin with progressive improvement.
Discussion: This is a case of ADEM of predominant spinal cord forcing the differential diagnosis with pictures of acute onset flaccid paraplegia. We highlight that herpesvirus 6 may be the agent of such a clinical picture.
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