Encefalomielite aguda disseminada com provável etiologia de Bartonella henselae / Acute disseminated encephalomyelitis with probable Bartonella henselae etiology

RESUMO A encefalomielite aguda disseminada é uma doença rara, aguda, inflamatória e desmielinizante do sistema nervoso central, presumivelmente associada, em mais de três quartos dos casos, a infecções (virais, bacterianas ou inespecíficas) e imunizações ou sem qualquer antecedente indentificável. Habitualmente, apresenta um curso monofásico com início de sintomas inespecíficos na fase prodrómica, podendo evoluir com alterações neurológicas multifocais e até à perda total da acuidade visual. Descrevemos o caso de um menino de 9 anos com quadro inicial de edema de papila causado por encefalomielite aguda disseminada devido a Bartonella henselae. Apesar da gravidade da doença, o diagnóstico e o tratamento precoce proporcionaram bons desfechos.

ABSTRACT Acute disseminated encephalomyelitis is a rare, acute, inflammatory, and demyelinating disease of the central nervous system. Presumably associated in more than three quarters of cases by infections (viral, bacterial, or nonspecific) and immunizations or without any identifiable antecedent. It usually presents a monophasic course with onset of nonspecific symptoms in the prodromal phase and may evolve with multifocal neurological changes and even visual acuity loss. We describe a case of a 9-year-old boy with an initial picture of papillary edema caused by acute disseminated encephalomyelitis due to Bartonella henselae. Despite the severity of the disease, early diagnosis and treatment provided good outcomes.

Encefalitis recurrente post vacuna influenza anual / Recurrent encephalitis following annual influenza vaccine: case report

Influenza vaccine is rarely associated with neurological adverse effects such as Guillain Barré syndrome, encephalitis or aseptic meningitis. We report the case of a male patient that presented two episodes of acute encephalitis in consecutive years, 16 and 20 days after his annual influenza vaccine shot, respectively. In both instances, patient required ICU admission and evolved with fast recovery and no sequels. The first episode was managed empirically as herpetic encephalitis but an extensive study was performed in the second episode without identifying any microorganism. Neuroimaging studies also discarded acute disseminated encephalomyelitis. Mild pleocytosis of mononuclear predominance was detected in both cases in CSF. Naranjo score punctuated 8 points indicating a probable causal relationship. Acute encephalitis is a rare adverse effect of influenza vaccine and occurs several days after immunization. It has a broad differential diagnosis, and appears to be of self-limited duration and associated with good prognosis.

La vacuna influenza en raras ocasiones se asocia a efectos adversos neurológicos tales como síndrome de Guillain Barré, encefalitis o meningitis aséptica, entre otros. Presentamos el caso clínico de un paciente de sexo masculino de 66 años que presentó dos episodios de encefalitis en años consecutivos, 16 y 20 días después de recibir la vacuna anual de influenza, respectivamente. En ambos casos requirió ingreso a UCI y evolucionó con una rápida recuperación y sin secuelas. El primer episodio fue manejado empíricamente como una encefalitis herpética y en el segundo se hizo un extenso estudio microbiológico que no identificó microorganismos. Los estudios de neuroimágenes descartaron una encefalomielitis aguda diseminada. En ambos casos se pesquisó pleocitosis de predominio mononuclear en el LCR. El score de Naranjo dio 8 puntos indicando una probable relación causal. La encefalitis aguda es un efecto adverso muy infrecuente tras la vacuna influenza y ocurre varios días después de la inmunización. Tiene un amplio diagnóstico diferencial, parece ser autolimitado y de buen pronóstico.

Acute disseminated encephalomyelitis following inactivated influenza vaccination in the Brazilian Amazon: a case report

Here, we describe a case of acute disseminated encephalomyelitis (ADEM) that occurred during a plausible risk interval following inactivated influenza vaccination in a previously healthy 27-year-old man from Manaus, Brazil. He was treated with intravenous methylprednisolone and immunoglobulin. One-month follow-up revealed resolution of the brain lesions, but not of the spinal cord lesions. No recurrence or progression of the main neurological symptoms was observed. After two years of monitoring, the patient continues to experience weak lower limbs and urinary retention. Thus, we recommend that ADEM should be considered in a patient presenting with neurological symptoms after influenza vaccination.

Acute disseminated encephalomyelitis following falciparum malaria.

Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease of the brain and spinal cord which is preceded by many viral and bacterial infections. We present a rare case of ADEM following falciparum malaria infection. Early identification of ADEM is highly required as it responds to treatment very well and delay in diagnosis may lead to permanent neurological sequelae.

Encefalopatía desmielinizante aguda post viral / Acute encephalopathy demyelinating post viral

La encefalomielites aguda diseminada (EMAD) es una forma de encefalitis postinfecciosa, de etiología diversa, que suele manifestarse después de un cuadro infeccioso vírico o bacteriano o después de una inmunización (1-2-3-). Se presenta especialmente en la infancia. Objetivo: describir dos casos clínicos de encefalopatía aguda diseminada post viral en el Servicio de Pediatría del HCIPS. Materiales y método: Análisis retrospectivo de historias clínicas de dos pacientes con diagnóstico de encefalopatía aguda diseminada post viral, internados en el Servicio de Pediatría del HCIPS. Conclusión: En los dos casos estudiados se dió el patrón de evolución clínico e imageneológico descripto en la literatura para encefalopatía desmielinizante aguda. Se sugiere considerar este diagnóstico ante un niño con compromiso encefálico que se instala posterior a una enfermedad vírica. la RNM cerebral es el estudio por imagen recomendado para estos casos por ser el test radilógico mas sensible y específico. Sc

Encefalomielitis aguda diseminada: reporte de un caso y revisión de la literatura / Acute disseminated encephalomyelitis: a case report and review of the literature

Introducción: la encefalomielitis aguda diseminada (EAD) es un trastorno neurológico caracterizado por inflamación del cerebro y médula espinal causado por un daño a la mielina, afectando al sistema nervioso central de manera difusa. Esta afección puede manifestarse de manera espontánea o secundaria a infecciones o a vacunación. La mayoría de las veces evoluciona de manera monofásica con manifestaciones clínicas inespecíficas, por lo que la sospecha diagnóstica es fundamental. Objetivo: Presentar un caso clínico de una patología infrecuente, con una revisión actualizada del tema. Caso clínico: Presentamos el caso de una paciente de 7 años de edad, de sexo femenino, portadora de EAD y se exponen la forma clínica de presentación, los hallazgos neurorradiológicos y el tratamiento realizado. Conclusión: La EAD es una patología poco frecuente, que puede tener un curso mortal. El diagnóstico definitivo se realiza a través de RM y el tratamiento más efectivo pareciera ser los corticoides, aunque un porcentaje de pacientes evoluciona espontáneamente a la mejoría.

Encefalomielite disseminada aguda pós-vacinal / Post-vaccinal acute disseminated encephalomyelitis

A ocorrência de desmielinizaçäo inflamatória do sestema nervoso central ou periférico, após doenças infecciosas agudas ou vacinhas, é reconhecida há longo tempo. Relata-se caso de Encefalomielite Disseminada Aguda (EDA), em pacientes de dez anos, após vacinaçäo em campanha de saúde pública anti-sarampo. Discutem-se os aspectos clínicos e imunopatológicos dessa afecçäo e, apoiando-se na literatura especializada, propöe-se uma estratégia de manuseio de EDA, fundamentada em suspeita precoce, diagnóstico e rápida instituiçäo de medidas terapêuticas apropriadas. A utilizaçäo de metilprednisolona em pulso encerra a manobra inicial, além de medidas de suporte clínico; plasmaferese e imunossupressores constituem opçöes complementares, em casos mais graves. Medidas preventivas (vacinaçäo contra doenças infecto-contagiosas, por exemplo)e avanços biotecnológicos, com desenvolvimento de vacinas menos imunogênicas, ensejam menor risco de EDA na populaçäo suscetível

A high incidence of neurological complications following Semple anti-rabies vaccine.

A study was conducted to determine the incidence of neurological complications among a cohort of 6,980 recipients of Semple vaccine administered in Bangkok and 5 nearby provinces in 1984. A review of all patients admitted to public hospitals in these 6 provinces discovered a total of 32 cases, with neurological complications following Semple vaccine. Twenty-two cases (68.8%) were encephalitis or myelitis. The complication rate was 3.6 times higher for males than females and the rate was lowest in the 0-14 year age group. Vaccinees receiving large daily dose of vaccine had a higher rate of complications than those with low dose regimen. One patient died, giving the case-fatality rate of 3.13 per cent. Since the search was limited, the rate of neurological complications to Semple vaccine was a minimum of 4.6 cases per 1,000 vaccinees [1:220]. This complication rate was much higher than most rates reported previously. It is imperative to find economically feasible alternatives to Semple vaccine.