Rituximab Treatment in Acute Disseminated Encephalomyelitis Associated with Salmonella Infection

Kaçmaz, Ebru; Bozan, Gürkan; Çarman, Kürşat Bora; Kılıç, Ömer; Arslanoğlu, Mehmet Özgür; Toprak, Uğur; Tufan, Aslı; Yarar, Çoşkun; Dinleyici, Ener Çağrı

doi:10.1155/2021/5570566

Cited by 2 publications

(1 citation statement)

References 13 publications

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“…High-dose steroids (30 mg/kg/day for 3 days) and intravenous immunoglobulin (IVIG; 2 g/kg/day) were administered to the patient without any clinical improvement. The patient received five cycles of plasma exchange therapy, after the parental declaration of informed consent, followed by off-label rituximab infusion (weekly infusion for 4 weeks) as reported in recent pediatric severe cases of ADEM (8). The patient showed partial clinical improvement along with important radiological improvement.…”

Section: Therapeutic Interventionmentioning

confidence: 99%

Case report: A case of acute disseminated encephalomyelitis after SARS-CoV-2 infection in pediatric patients

et al. 2023

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IntroductionSince the beginning, there has been enough evidence about the multi-systematic involvement of the coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Recent observations have revealed that, together with others, typical neurological manifestations are also associated with COVID-19 infection. In the first 2 years, children accounted for a few percent of cases, but with the emergence of the Omicron variant, the number of cases in the pediatric population has increased. It has been described that ~5% of the affected population suffered from severe neurological complications, such as seizure, coma, encephalitis, demyelinating disorders, and aseptic meningitis. Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system. Typically, it presents in childhood and occurs 1 or 2 weeks after infection or vaccination.Case presentationWe present the case of a 12-year-old boy who developed ADEM, 10 days after an asymptomatic SARS-CoV-2 infection. Neurological symptoms began with headache, fever, irritability, paraplegia, and loss of sensitivity from the T1 level. The diagnosis of ADEM was confirmed by the typical signs found on brain MRI, whereas spinal cord MRI showed signs of transverse myelitis. The cerebrospinal fluid (CSF) testing excluded infections and did not reveal oligoclonal antibody bands (anti-MOG-negative and anti-AQP-negative). High-dose steroids (30 mg/kg/day) and IVIG (2 g/kg) were administered to the patient without any clinical improvement. The patient received a cycle of plasma exchange therapy, followed by rituximab infusion, with partial improvement. After 3 months, the magnetic resonance imaging (MRI) results demonstrated radiological improvement in accordance with the ADEM diagnosis.ConclusionThis clinical case confirms that SARS-CoV-2 infections are increasingly implicated in severe neurological consequences in both adult and pediatric patients. While the most frequent complications that were reported in children included headache, altered mental status, and encephalopathy, ~5% of the individuals suffered from severe neurological complications, leading to lifelong sequelae. All physicians must be aware of these data and detect neurological signs of severe (or not) complications that require a specific follow-up and treatment.

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Section: Therapeutic Interventionmentioning

confidence: 99%

Case report: A case of acute disseminated encephalomyelitis after SARS-CoV-2 infection in pediatric patients

et al. 2023

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Acute disseminated encephalomyelitis as an emergency

Yevtushenko,

Sorokin

2024

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Acute disseminated encephalomyelitis (ADEM) is a common acute multifocal autoimmune infl ammatory demyelinating disease of the central nervous system (CNS) with a predominant lesion of the white matter of the brain, brainstem and optic nerves, the conductors of the spinal cord, less often — gray matter of the CNS. ADEM is usually a self-limiting condition with spontaneous improvement and a favorable prognosis. Along with the possibility of a severe course in the classical form of ADEM, the development of hyperacute forms with a much more unfavorable prognosis is possible. Such variants of the course of ADEM are acute hemorrhagic leukoencephalitis (AHLE), acute hemorrhagic leukoencephalomyelitis and acute necrotizing hemorrhagic leukoencephalitis of Hurst, associated with the development of a cascade of hyperacute uncontrolled autoimmune reactions. The severity of these conditions (grouped under the term OHLE) is associated with rapid progression, brainstem involvement, large lesions is due to the development of acute edematous necrosis and hemorrhage with a high possibility of disability or death. The aggressive and severe course of АHLE requires the immediate initiation of decongestant and immunosuppressive therapy.

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Rituximab Treatment in Acute Disseminated Encephalomyelitis Associated with Salmonella Infection

Cited by 2 publications

References 13 publications

Case report: A case of acute disseminated encephalomyelitis after SARS-CoV-2 infection in pediatric patients

Case report: A case of acute disseminated encephalomyelitis after SARS-CoV-2 infection in pediatric patients

Acute disseminated encephalomyelitis as an emergency

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