Encefalomielitis aguda diseminada fulminante en un paciente pediátrico: reporte de caso y revisión de la literatura

Acute disseminated encephalomyelitis (ADEM), belongs to a group of disorders characterized by the acute or subacute appearance of neurological deficits with evidence of inflammatory demyelination of the central nervous system (CNS), is a rare pathology that mainly affects children and young adults., it is considered that 50-80% of cases occur after involvement of the lower respiratory tract, gastrointestinal system or exanthematous disease; The associated infectious agents are viruses. Diagnostic evaluation includes cerebrospinal fluid and neuroimaging studies to evaluate the multifocal brain lesions characteristic of ADEM; Treatment consists of intravenous corticosteroids, therapeutic plasma exchange, and intravenous immunoglobulin. This is a 2-year-old male preschooler, who initially presents with respiratory and gastrointestinal symptoms, later with neurological deterioration, presenting seizures characterized by tonic posture that progresses to bilateral clonic movements, poor pupillary response, comatose state, and no response to nociceptive stimuli. and truncal hypotonia, performed brain MRI where extensive lesions involving the supra- and infratentorial white matter were observed, compatible with ADEM. Fortunately, it is a disease with a good prognosis and clinical evolution; however, this case shows that not all patients have a good response to the management established, which leads to the need to establish markers specific to this pathology that allow a diagnosis directed from the moment of suspected diagnosis in order to prevent possible complications and associated neurological sequelae.