title: Acute disseminated encephalomyelitis mimicking late CNS relapse of acute lymphoblastic leukaemia: case report.
abstract: BACKGROUND
  Acute encephalomyelopathy occurring after an allogeneic bone marrow transplant for leukaemia is a diagnostic emergency. The diagnosis can be challenging since there is a wide set of alternative diagnoses, including opportunistic infections and relapse of the leukaemia.
  
  
  METHODS
  A 13-year old girl presented with a severe acute myelopathy and encephalopathy. She was in prolonged remission from a central nervous system and bone marrow relapse of an acute lymphoblastic leukaemia, treated with allogeneic bone marrow transplantation. Neuroimaging showed multifocal grey and white matter lesions of demyelinating appearance in the brain and entire spine. Immunophenotyping and cytogenetic investigations of the girl's cerebrospinal fluid lymphocytosis excluded a late central nervous system relapse of her leukaemia. The diagnosis was acute disseminated encephalomyelitis. With standard immunosuppressive therapy, the girl had early cerebral recovery but a prolonged period of recovery from her myelopathy.
  
  
  CONCLUSIONS
  Acute disseminated encephalomyelitis should be considered in the differential diagnosis of acute encephalomyelopathy after bone marrow transplantation for leukaemia. Demyelinating syndromes such as acute disseminated encephalomyelitis may be late sequelae of bone marrow transplantation.
authors.affiliation: Department of Paediatric Neurology, Royal Manchester Children's Hospital, Hospital Road, Manchester, UK. kumarr1@doctors.org.uk.
authors.forename: Ram
authors.initials: R
authors.lastname: Kumar
authors.forename: Shobha
authors.initials: S
authors.lastname: Nijalingappa
authors.forename: John
authors.initials: J
authors.lastname: Grainger
authors.forename: Omar
authors.initials: O
authors.lastname: Ismayl