ACUTE DISSEMINATED ENCEPHALOMYELITIS FOLLOWING INFECTION WITH MYCOPLASMA PNEUMONIAE AND BURKHOLDERIA PSEUDOMALLEI: A CASE REPORT

Abstract

Acute disseminated encephalomyelitis (ADEM) is an immune-mediated, monophasic demyelinating disease that predominantly occurs in children with post-viral infection or post-vaccination setting but rarely after infection with Mycoplasma, Burkholderia, Chlamydia, Legionella, Campylobacter or Streptococcus. We present here a case of a 5-year-old girl with a history of cough for 2 months, fever and altered consciousness. She was treated with 2 courses of oral antibiotics prior to admission. An initial cerebrospinal fluid specimen obtained showed lymphocytic infiltration suggesting resolved pneumonia complicated with meningoencephalitis. She was initially treated with a 3-week course of intravenous azithromycin for Mycoplasma. pneumoniae infection as serum mycoplasma antibody titer was elevated. A subsequent alteration in sensorium warranted a magnetic resonance imaging of the brain, which was consistent with ADEM and steroid therapy was instituted. However, there were persistent fever and thrombocytosis; laboratory testing at this point revealed elevated Burkholderia pseudomallei IgM antibody titers. She received a total of 8 weeks of intravenous meropenam and trimethoprim/sulfamethoxazole followed by an additional 6 months of oral trimethoprim/sulfamethoxazole. She recovered completely without any residual symptoms. Patients who present with neurological symptoms with a history of recent infection with M. pneumoniae and/or B. pseudomallei should be evaluated for the presence of ADEM and treated accordingly