A Case of Acute Disseminated Encephalomyelitis Presenting with Bilateral Optic Neuritis associated with Mycoplasma pneumoniae
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Mycoplasma pneumoniae(M. pneumoniae) is a well-known human respiratory pathogen. It also affects various organ systems and causes extrapulmonary complications, including neurologic, cutaneous, hematologic and ophthalmologic complications. M. pneumoniae has been implicated in a number of immune-mediated neurological diseases, such as ADEM, Gullian- Barré syndrome, and transverse myelitis. We present a 5-year-old boy with bilateral optic neuritis related to ADEM and pruritic skin lesions simultaneously associated with M. pneumoniae infection. He developed a headache with decreased activity six weeks before admission. He had no respiratory symptoms. Cerebral MRI showed multiple bilateral subcortical white matter lesions, suggesting a radiologic diagnosis of ADEM. M. pneumoniae was positive serologically. The cerebrospinal fluid polymerase chain reaction for M. pneumoniae was negative. The treatment with intravenous high-dose steroids and oral clarithromycin resulted in the rapid recovery of the patients visual and cutaneous problems. He was found to have returned to his normal conditions in the follow-up examination. We believe that immune-mediated injury can explain all the clinical manifestations of our case, which are ADEM-associated optic neuritis and cutaneous lesions.
Abstract
Mycoplasma pneumoniae(M. pneumoniae) is a well-known human respiratory pathogen. It also affects various organ systems and causes extrapulmonary complications, including neurologic, cutaneous, hematologic and ophthalmologic complications. M. pneumoniae has been implicated in a number of immune-mediated neurological diseases, such as ADEM, Gullian- Barré syndrome, and transverse myelitis. We present a 5-year-old boy with bilateral optic neuritis related to ADEM and pruritic skin lesions simultaneously associated with M. pneumoniae infection. He developed a headache with decreased activity six weeks before admission. He had no respiratory symptoms. Cerebral MRI showed multiple bilateral subcortical white matter lesions, suggesting a radiologic diagnosis of ADEM. M. pneumoniae was positive serologically. The cerebrospinal fluid polymerase chain reaction for M. pneumoniae was negative. The treatment with intravenous high-dose steroids and oral clarithromycin resulted in the rapid recovery of the patients visual and cutaneous problems. He was found to have returned to his normal conditions in the follow-up examination. We believe that immune-mediated injury can explain all the clinical manifestations of our case, which are ADEM-associated optic neuritis and cutaneous lesions.
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