title: Adult acute disseminated encephalomyelitis associated with poststreptococcal infection.
abstract: Acute disseminated encephalomyelitis (ADEM) is a monophasic illness that is thought to develop from antigenic mimicry with antibodies having cross-reactivity to host epitopes in the nervous system. The disorder typically follows an exanthematous or recent viral infection. In contrast, complications from bacterial poststreptococcal infections more commonly give rise to disorders in the pediatric population including Sydenham's chorea, pediatric autoimmune neuropsychiatric disorders, and ADEM. We present the novel case of documented streptococcal pharyngitis and elevated antideoxyribonuclease B (ADNB) titers in an adult giving rise to ADEM. Furthermore, the absence of basal ganglia abnormalities on MRI and the degree of leukocytosis in the CSF distinguish the adult form of ADEM from childhood ADEM and adult viral demyelinating diseases.
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Ning
authors.forename: S
authors.initials: S
authors.lastname: Smirnakis
authors.forename: K L
authors.initials: KL
authors.lastname: Furie
authors.forename: V L
authors.initials: VL
authors.lastname: Sheen
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001479:Basal Ganglia / Q000473:pathology; D003851:Deoxyribonucleases / Q000378:metabolism; D004673:Encephalomyelitis, Acute Disseminated / Q000209:etiology* / Q000473:pathology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007964:Leukocytosis / Q000134:cerebrospinal fluid; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D010612:Pharyngitis / Q000150:complications / Q000382:microbiology; D013290:Streptococcal Infections / Q000150:complications* / Q000382:microbiology
chemical_list: D000893:Anti-Inflammatory Agents; D016756:Immunoglobulins, Intravenous; D003851:Deoxyribonucleases; C020069:deoxyribonuclease B; D008775:Methylprednisolone