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Acute Disseminated Encephalomyelitis Following Meningoencephalitis: Case Report and Literature Review

Elias, Matthew D. MD*; Narula, Sona MD; Chu, Andrew S. MD*

doi: 10.1097/PEC.0000000000000107
Illustrative Cases

Meningoencephalitis and acute disseminated encephalomyelitis (ADEM) are both neurological disease processes, but there have been few cases of meningoencephalitis progressing to ADEM in the pediatric population. A case of a 4-year-old girl with an initial diagnosis of meningoencephalitis is presented here, whose initial presentation was manifested by prolonged fever, gray matter signal abnormality on brain magnetic resonance imaging, cerebrospinal fluid pleocytosis, and a markedly irritable mental status. As her neurological examination changed with focal abnormalities, a repeat magnetic resonance imaging demonstrated new areas of both gray and white matter signal abnormality, consistent with ADEM. Her symptoms and imaging findings completely resolved with a course of methylprednisolone. Based on the literature and this current case, it is our recommendation to consider ADEM as a diagnosis if meningoencephalitis is not improving.

From the Divisions of *General Pediatrics and †Neurology, The Children’s Hospital of Philadelphia, Philadelphia, PA.

Disclosure: The authors declare no conflict of interest.

Reprints: Matthew D. Elias, MD, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Blvd, Pediatric Residency Program, Suite 9NW55, Philadelphia, PA 19104 (e-mail:

© 2014 Lippincott Williams & Wilkins, Inc.