Open AccessFatal acute disseminated encephalomyelitis associated with cytomegalovirus infection
Author(s) -
Reut Zaguri,
Ilan Shelef,
Gal Ifergan,
Yaniv Almog
Publication year - 2009
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr.07.2008.0443
Subject(s) - medicine , acute disseminated encephalomyelitis , magnetic resonance imaging , coma (optics) , methylprednisolone , differential diagnosis , cytomegalovirus , computed tomography , neurology , encephalitis , pediatrics , encephalomyelitis , radiology , multiple sclerosis , surgery , pathology , viral disease , immunology , herpesviridae , virus , psychiatry , physics , optics
We present the case of a young man with recent cytomegalovirus (CMV) infection who was admitted with generalised seizure and coma. Computed tomography scan and magnetic resonance imaging (MRI) on admission were normal. Despite transient initial improvement he rapidly deteriorated leading to repeated MRI that revealed findings highly suggestive of acute haemorrhagic leucoencephalitis (AHLE). The patient died despite treatment with pulse methylprednisolone and intravenous immunoglobulin. Acute disseminated encephalomyelitis (ADEM)/AHLE should be considered in the differential diagnosis of rapid neurological deterioration even when initial imaging is normal. This case report underscores the importance of early diagnosis as early aggressive treatment may improve outcome.