Encephalomyelitis as the first manifestation of scrub typhus

@#Scrub typhus is a zoonotic disease caused by Orientia tsutsugamushi. We report here a middle-aged man with 3 days history of mild fever, dysphagia, and anarthria. On examination, he had nystagmus, quadriparesis, and a fresh eschar in the left scrotal region. Cerebrospinal fluid (CSF) and serum samples were positive for tsutsugamushi antibody. The magnetic resonance images (MRIs) showed T2 lesions in the brainstem, basal ganglia, frontal, corona radiate and spinal cord. After treatment with chloramphenicol and prednisolone, the clinical symptoms and signs improved. Our case highlights that encephalomyelitis may be caused by rickettsial disease such as scrub typhus.

Acute Disseminated Encephalomyelitis with Measles.

Acute disseminated encephalomyelitis is an inflammatory demyelinating illness usually associated with infections or antecedent immunization. Due to control of most vaccine preventable diseases in developed countries, most cases of acute disseminated encephalomyelitis occur in developing countries and are seen secondary to nonspecific upper respiratory tract infections. We report a case of acute disseminated encephalomyelitis associated with measles in a 2½-year-old male child despite having measles vaccination in infancy. The diagnosis was based on clinical findings and CT scan of brain. The patient was managed with high dose corticosteroids along with supportive measures. He recovered completely and follow-up for six months revealed no neurological deterioration.

High-dose Methylprednisolone Pulse Therapy in Measles Postinfectious Encephalomyelitis: Two Cases of Successful Recovery / 대한소아신경학회지

We treated two patients of measles postinfectious encephalomyelitis with intravenous methylprednisolone pulse therapy(1 g/1.73 m2/day for 5 days) 38 hours and 5 days respectively after the onset of neurologic symptoms. Despite extensive white matter involvement shown in MRI and severe clinical symptoms, the patients recovered from their neurologic symptoms dramatically following intravenous methylprednisolone pulse therapy. Because acute postinfectious encephalomyelitis has been postulated to be immunologically mediated disease, instead of direct viral invasion, ACTH and dexamethasone are widely used and the outcome is variable. This case report of successful recovery from fulminant ADEM with pulse intravenous methylprednisolone therapy, although uncontrolled, suggests that this therapeutic regimen should be studied in other cases.