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A case of acute disseminated encephalomyelitis following Mycoplasma pneumoniae infection

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...

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Autores principales: Laila, Alla, El-Lababidi, Rania M., Hisham, Mohamed, Mooty, Mohammad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6011136/
https://www.ncbi.nlm.nih.gov/pubmed/29942745
http://dx.doi.org/10.1016/j.idcr.2018.03.003
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author Laila, Alla
El-Lababidi, Rania M.
Hisham, Mohamed
Mooty, Mohammad
author_facet Laila, Alla
El-Lababidi, Rania M.
Hisham, Mohamed
Mooty, Mohammad
author_sort Laila, Alla
collection PubMed
description 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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spelling pubmed-60111362018-06-25 A case of acute disseminated encephalomyelitis following Mycoplasma pneumoniae infection Laila, Alla El-Lababidi, Rania M. Hisham, Mohamed Mooty, Mohammad IDCases Article 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. Elsevier 2018-03-12 /pmc/articles/PMC6011136/ /pubmed/29942745 http://dx.doi.org/10.1016/j.idcr.2018.03.003 Text en © 2018 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Article
Laila, Alla
El-Lababidi, Rania M.
Hisham, Mohamed
Mooty, Mohammad
A case of acute disseminated encephalomyelitis following Mycoplasma pneumoniae infection
title A case of acute disseminated encephalomyelitis following Mycoplasma pneumoniae infection
title_full A case of acute disseminated encephalomyelitis following Mycoplasma pneumoniae infection
title_fullStr A case of acute disseminated encephalomyelitis following Mycoplasma pneumoniae infection
title_full_unstemmed A case of acute disseminated encephalomyelitis following Mycoplasma pneumoniae infection
title_short A case of acute disseminated encephalomyelitis following Mycoplasma pneumoniae infection
title_sort case of acute disseminated encephalomyelitis following mycoplasma pneumoniae infection
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6011136/
https://www.ncbi.nlm.nih.gov/pubmed/29942745
http://dx.doi.org/10.1016/j.idcr.2018.03.003
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