Seropositive anti-MOG antibody-associated acute disseminated encephalomyelitis (ADEM): a sequelae ofMycoplasmapneumoniaeinfection

Abstract

Acute disseminated encephalomyelitis (ADEM) is a demyelinating, autoimmune disease of the central nervous system (CNS). It causes motor and sensory deficits, altered mental status and other neurological symptoms. Though rarely fatal, it has been associated with residual motor and neurocognitive deficits. Our case consisted of a 4-year-old girl who presented with fatigue and unsteady gait after a respiratory illness. During her hospital course, she became progressively weaker and experienced seizures. Imaging showed sections of demyelination in the CNS, and appropriate treatment was started. Additional labs resulted in positive Mycoplasma pneumoniae serum serology. Antimyelin oligodendrocyte glycoprotein (anti-MOG) antibodies were also found, which is a risk factor for relapsing, multiphasic ADEM. To our knowledge, this is the first case of anti-MOG antibody-associated ADEM due to M. pneumoniae infection. Our patient has made a complete recovery. The parents only report slightly increased fatigue and irritability.

A Case of Acute Disseminated Encephalomyelitis Accompanying Intussusception Associated with Mycoplasma pneumoniae Infection

“…It is unclear whether repetitive irritability was a symptom of ADEM, as the patient may have had intussusception-or mesenteric lymphadenopathy-associated irritability. Several cases of mycoplasma infection-associated ADEM have been reported to involve immune-mediated demyelination following respiratory in- fection; in those cases, the bacterium was detected in respiratory samples but not in CSF samples, as in our case [5][6][7][8]. Furthermore, our patient showed an excellent response to steroid pulse therapy, indicating an immune-mediated etiology of ADEM secondary to mycoplasma infection.…”

A case of anti-myelin oligodendrocyte glycoprotein (MOG)-immunoglobulin G (IgG) associated disorder (MOGAD) with clinical manifestations of acute disseminated encephalomyelitis: Secondary to mycoplasma pneumoniae infection

“…M. pneumoniae infection has also been reported, but it is relatively rare [ 6 ]. The MOGAD presenting as ADEM secondary to M. pneumoniae infection has only been reported by Bonagiri P et al [ 4 ]. The case we report is unique because it represents a biphasic course.…”

“…In children, ADEM is a common clinical manifestation of MOGAD [ 2 ], and is thought to be related to previous stimuli such as a viral infection or immunity, with an annual incidence of approximately 0.3–0.6 per 100 000 children [ 3 ]. ADEM cases caused by M. pneumoniae infection have been confirmed, but there are few reports of anti-MOG -IgG-related ADEM caused by M. pneumoniae infection [ 4 ]. However, the pathogenesis of CNS demyelination induced by M. pneumoniae infection remains unclear.…”

The Role of Microorganisms in the Etiopathogenesis of Demyelinating Diseases

“…ADEM is the most common manifestation in the pediatric population and often occurs after infection with EBV, measles, influenza, enterovirus, coronavirus, herpes simplex and, rarely, Mycoplasma pneumoniae [ 181 , 182 , 183 , 184 , 185 , 186 , 187 , 188 , 189 , 190 ]. Recently, it has been observed that previous infection is more common during the monophasic course of the disease [ 191 ].…”