Next Article in Journal
Effectiveness of a Real-Time Ventilation Feedback Device for Guiding Adequate Minute Ventilation: A Manikin Simulation Study
Next Article in Special Issue
Postoperative Delirium in Patients with Chronic Obstructive Pulmonary Disease after Coronary Artery Bypass Grafting
Previous Article in Journal
Combination of a Self-Regulation Module and Mobile Application to Enhance Treatment Outcome for Patients with Acne
Previous Article in Special Issue
Natriuretic Peptides as a Prognostic Marker for Delirium in Cardiac Surgery—A Pilot Study
Open AccessCase Report

Acute Disseminated Encephalomyelitis with Seizures and Myocarditis: A Fatal Triad

1
Department of Pediatrics, Interdisciplinary Pediatric Intensive Care Medicine, University Medical Center Rostock, 18057 Rostock, Germany
2
Department of Pediatrics, Neuropediatrics, University Medical Center Rostock, 18057 Rostock, Germany
3
Department of Neuroimmunology, The National Hospital for Neurology and Neurosurgery, Queen Square, UCL Institute of Neurology, London WC1N 3BG, UK
4
Institute of Legal Medicine, University Medical Center Rostock, 18055 Rostock, Germany
5
Department of Pediatrics, University Medical Center Rostock, 18057 Rostock, Germany
6
Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Interventional Radiology, University Medical Center Rostock, 18057 Rostock, Germany
7
Institute of Neuropathology, University Medical Center Göttingen, 37073 Göttingen, Germany
8
Department of Anesthesiology and Intensive Care Medicine, Interdisciplinary Pediatric Intensive Care Medicine, University Medical Center Rostock, 18057 Rostock, Germany
9
Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Rostock, 18057 Rostock, Germany
*
Author to whom correspondence should be addressed.
Medicina 2020, 56(6), 277; https://doi.org/10.3390/medicina56060277
Received: 5 May 2020 / Revised: 30 May 2020 / Accepted: 1 June 2020 / Published: 4 June 2020
(This article belongs to the Special Issue Delirium in Critically Ill Patients)
Autoimmune pathology of acute disseminated encephalomyelitis (ADEM) is generally restricted to the brain. Our objective is to expand the phenotype of ADEM. A four-year-old girl was admitted to the pediatric emergency room of a university medical center five days after a common upper respiratory tract infection. Acute symptoms were fever, leg pain, and headaches. She developed meningeal signs, and her level of consciousness dropped rapidly. Epileptic seizure activity started, and she became comatose, requiring intubation and mechanical ventilation. Serial brain magnetic resonance imaging (MRI) illustrated the fulminant development of ADEM. Treatment escalation with high-dose corticosteroids, immunoglobulins, and plasma exchange did not lead to clinical improvement. On day ten, the patient developed treatment-refractory cardiogenic shock and passed away. The postmortem assessment confirmed ADEM and revealed acute lymphocytic myocarditis, likely explaining the acute cardiac failure. Human metapneumovirus and picornavirus were detected in the tracheal secrete by PCR. Data sources–medical chart of the patient. This case is consistent with evidence from experimental findings of an association of ADEM with myocarditis as a postinfectious systemic autoimmune response, with life-threatening involvement of the brain and heart. View Full-Text
Keywords: delirium; critical ill patient; critical illness; ADEM delirium; critical ill patient; critical illness; ADEM
Show Figures

Figure 1

MDPI and ACS Style

Lademann, H.; Bertsche, A.; Petzold, A.; Zack, F.; Büttner, A.; Däbritz, J.; Hauenstein, C.; Bahn, E.; Spang, C.; Reuter, D.; Warnke, P.; Ehler, J. Acute Disseminated Encephalomyelitis with Seizures and Myocarditis: A Fatal Triad. Medicina 2020, 56, 277.

Show more citation formats Show less citations formats
Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Article Access Map by Country/Region

1
Back to TopTop