João Alfredo M. M. Barros, Arthur Felipe Barbosa Vasconcelos, Francisco Anderson de Sá Carvalho, Gilmar Leite Pessoa Filho, Ana Luísa Castelo Branco Gomes, Raíssa N. L. F. Leite, João Felipe Bezerra, Juliana Magalhães Leite, Rafael de Souza Andrade, Bianca Etelvina Santos de Oliveira, Alex T. Meira
{"title":"一名感染基孔肯雅病毒的成年患者的 ADEM 病例报告","authors":"João Alfredo M. M. Barros, Arthur Felipe Barbosa Vasconcelos, Francisco Anderson de Sá Carvalho, Gilmar Leite Pessoa Filho, Ana Luísa Castelo Branco Gomes, Raíssa N. L. F. Leite, João Felipe Bezerra, Juliana Magalhães Leite, Rafael de Souza Andrade, Bianca Etelvina Santos de Oliveira, Alex T. Meira","doi":"10.1111/cen3.12795","DOIUrl":null,"url":null,"abstract":"<p>Acute Disseminated Encephalomyelitis (ADEM) is a demyelinating immune-mediated disease characterized by bilateral and confluent lesions in white matter (WM), with an acute onset. This condition may arise due to a myriad of etiological factors, encompassing mainly vaccines and viral infections. This case report describes a 39-y-old patient who presented with a sudden onset of fever, confusion, and reduced level of consciousness, associated with paraparesis in the lower limbs and urinary retention, 2 d before admission to the neurological emergency department. The work-up included analysis of the cerebrospinal fluid (CSF), which showed 1.6 cells/mm<sup>3</sup> and elevated proteins (91 g/dL); in addition to magnetic resonance imaging (MRI) of the brain and the spinal cord, in which hyperintense ovoid lesions with asymmetrical and bilateral distribution in the WM and basal ganglia were observed in the T2 and FLAIR. Later, chikungunya virus was detected in a molecular viral panel in the CSF. The patient exhibited an improvement radiologically, and in his condition following pulse with methylprednisolone and intravenous immunoglobulin therapy, and 40 mg of prednisone was prescribed for management during outpatient follow-up. This study highlights arbovirus infections as a possible cause of acute neurological conditions, involving both the brain and the spinal cord. Furthermore, the findings observed in the report were compared with those described in the literature, including other arboviruses. In conclusion, it was observed that the majority of patients responded to treatment with corticosteroids or immunoglobulins, with some neurological deficits eventually persisting. Therefore, more studies are needed to better investigate therapeutic options.</p>","PeriodicalId":10193,"journal":{"name":"Clinical and Experimental Neuroimmunology","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Case report of ADEM in an adult patient with chikungunya\",\"authors\":\"João Alfredo M. M. Barros, Arthur Felipe Barbosa Vasconcelos, Francisco Anderson de Sá Carvalho, Gilmar Leite Pessoa Filho, Ana Luísa Castelo Branco Gomes, Raíssa N. L. F. Leite, João Felipe Bezerra, Juliana Magalhães Leite, Rafael de Souza Andrade, Bianca Etelvina Santos de Oliveira, Alex T. Meira\",\"doi\":\"10.1111/cen3.12795\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>Acute Disseminated Encephalomyelitis (ADEM) is a demyelinating immune-mediated disease characterized by bilateral and confluent lesions in white matter (WM), with an acute onset. This condition may arise due to a myriad of etiological factors, encompassing mainly vaccines and viral infections. This case report describes a 39-y-old patient who presented with a sudden onset of fever, confusion, and reduced level of consciousness, associated with paraparesis in the lower limbs and urinary retention, 2 d before admission to the neurological emergency department. The work-up included analysis of the cerebrospinal fluid (CSF), which showed 1.6 cells/mm<sup>3</sup> and elevated proteins (91 g/dL); in addition to magnetic resonance imaging (MRI) of the brain and the spinal cord, in which hyperintense ovoid lesions with asymmetrical and bilateral distribution in the WM and basal ganglia were observed in the T2 and FLAIR. Later, chikungunya virus was detected in a molecular viral panel in the CSF. The patient exhibited an improvement radiologically, and in his condition following pulse with methylprednisolone and intravenous immunoglobulin therapy, and 40 mg of prednisone was prescribed for management during outpatient follow-up. This study highlights arbovirus infections as a possible cause of acute neurological conditions, involving both the brain and the spinal cord. Furthermore, the findings observed in the report were compared with those described in the literature, including other arboviruses. In conclusion, it was observed that the majority of patients responded to treatment with corticosteroids or immunoglobulins, with some neurological deficits eventually persisting. Therefore, more studies are needed to better investigate therapeutic options.</p>\",\"PeriodicalId\":10193,\"journal\":{\"name\":\"Clinical and Experimental Neuroimmunology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-05-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical and Experimental Neuroimmunology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/cen3.12795\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Immunology and Microbiology\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical and Experimental Neuroimmunology","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/cen3.12795","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Immunology and Microbiology","Score":null,"Total":0}
Case report of ADEM in an adult patient with chikungunya
Acute Disseminated Encephalomyelitis (ADEM) is a demyelinating immune-mediated disease characterized by bilateral and confluent lesions in white matter (WM), with an acute onset. This condition may arise due to a myriad of etiological factors, encompassing mainly vaccines and viral infections. This case report describes a 39-y-old patient who presented with a sudden onset of fever, confusion, and reduced level of consciousness, associated with paraparesis in the lower limbs and urinary retention, 2 d before admission to the neurological emergency department. The work-up included analysis of the cerebrospinal fluid (CSF), which showed 1.6 cells/mm3 and elevated proteins (91 g/dL); in addition to magnetic resonance imaging (MRI) of the brain and the spinal cord, in which hyperintense ovoid lesions with asymmetrical and bilateral distribution in the WM and basal ganglia were observed in the T2 and FLAIR. Later, chikungunya virus was detected in a molecular viral panel in the CSF. The patient exhibited an improvement radiologically, and in his condition following pulse with methylprednisolone and intravenous immunoglobulin therapy, and 40 mg of prednisone was prescribed for management during outpatient follow-up. This study highlights arbovirus infections as a possible cause of acute neurological conditions, involving both the brain and the spinal cord. Furthermore, the findings observed in the report were compared with those described in the literature, including other arboviruses. In conclusion, it was observed that the majority of patients responded to treatment with corticosteroids or immunoglobulins, with some neurological deficits eventually persisting. Therefore, more studies are needed to better investigate therapeutic options.