title: Acute disseminated encephalomyelitis after mixed malaria infection (Plasmodium falciparum and Plasmodium vivax) with MRI closely simulating multiple sclerosis.
abstract: BACKGROUND
  Acute disseminated encephalomyelitis (ADEM) is a monophasic, inflammatory, immune-mediated disorder of the central nervous system. It is particularly difficult to distinguish between ADEM and an initial attack of multiple sclerosis (MS) clinically and based on magnetic resonance imaging (MRI) or cerebrospinal fluid. ADEM is quite rare after malaria infection. Our patient, although diagnosed provisionally of ADEM after mixed malaria infection, had neuroimaging closely simulating MS.
  
  
  METHODS
  We report a case of a woman with an adult type 2 diabetes presenting with fever and diagnosed by antigen assay to be suffering from mixed malaria infection (Plasmodium falciparum, Plasmodium vivax). While recovering with artesunate and doxycycline therapy, she developed acute onset bladder retention followed by paraparesis. On examination she had evidence of Upper Motor Neuron (UMN) signs in all the 4 limbs along with truncal sensory loss.
  
  
  CONCLUSIONS
  Her MRI of spine showed T2 hyperintensities suggestive of resolving myelitis. MRI of the brain showed multifocal and confluent areas of demyelination mostly involving the corpus callosum and periventricular region. Lesions, particularly the callosal ones, closely simulated MS. In accordance with the McDonald Criteria and Barkhof's MRI Criteria, this patient did not fit into the diagnosis of MS. Our provisional diagnosis was ADEM.
authors: Department of Medicine, Medical College, Kolkata, India. Siddhartha.Mani83@gmail.com
authors: Siddhartha
authors: S
authors: Mani
authors: Soumya Sarathi
authors: SS
authors: Mondal
authors: Goutam
authors: G
authors: Guha
authors: Subhabrata
authors: S
authors: Gangopadhyay
authors: Adyapad
authors: A
authors: Pani
authors: Sumanta
authors: S
authors: Das Baksi
authors: Debjoy
authors: D
authors: Sau
authors: Koushik
authors: K
authors: Bhattacharjee
mesh_terms: D000328:Adult; D004673:Encephalomyelitis, Acute Disseminated / Q000175:diagnosis* / Q000382:microbiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009103:Multiple Sclerosis / Q000503:physiopathology*; D010963:Plasmodium falciparum / Q000472:pathogenicity*; D010966:Plasmodium vivax / Q000472:pathogenicity*; D013116:Spinal Cord / Q000382:microbiology / Q000473:pathology