Diagnostic Challenges in a Nine-year-old Boy with ADEM and Longitudinal Extensive Transverse Myelitis

Abstract

Acute disseminated encephalomyelitis (ADEM), or postinfectious encephalomyelitis, is a demyelinating central nervous system disease that typically presents with multifocal neurologic symptoms and encephalopathy. Numerous pathogens have been associated with ADEM, and the implicated viruses include coronavirus, coxsackie, cytomegalovirus, Epstein-Barr, herpes simplex, hepatitis A, HIV, influenza, measles, rubella, varicella zoster, and adenovirus. Although severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection has been associated with ADEM, the incidence is quite low. We present the case of a 9-year-old boy with ADEM plus longitudinal extensive myelitis who had a SARS-CoV-2 infection history and acute adenovirus infection. We evaluated the diagnosis and treatment challenges. Although our patient had severe neurological respiratory failure requiring intubation and tetraplegic flaccid paralysis, he had a total recovery before hospital discharge.

Keywords

• adem
• adenovirus
• covid-19
• transverse myelitis
• children
• rituximab