YL Yu, HF Li, ZZ Xia, F Gao

Abstract

Acute disseminated encephalomyelitis (ADEM) is an autoimmune demyelinating disease of the central nervous system. We report a 4-year-old girl who suffered from acute meningoencephalitis caused by Streptococcus pneumoniae (S. pneumoniae). After 8 days of treatment by sensitive antibiotics, the cerebrospinal fluid (CSF) cell count, blood count and the serum level of C-reactive protein recovered quickly, while the level of CSF protein was still high, with continuous coma and fever. Magnetic resonance imaging indicated multifocal changes in the brain parenchyma, mainly in white matter, with bithalamic involvement. The CSF IgG index increased, oligoclonal bands were positive. After high-dose intravenous methylprednisolone and intravenous immunoglobulin were given, the patient came around, with normal CSF results and body temperature. Within a few months the patient recovered completely and there were no relapses during nearly 3 years of follow-up. To our knowledge, this may be the first report of ADEM following S. pneumoniae meningoencephalitis in children.