title: An infant with steroid-refractory cytomegalovirus-associated ADEM who responded to immunoglobulin therapy.
abstract: Acute disseminated encephalomyelitis (ADEM) develops via an immunological mechanism. We encountered a 10-month-old infant with a rare pathogenesis of cytomegalovirus (CMV)-related ADEM. The patients complaints were; protracted fever; consciousness disorder; and affected cervical stability. Cerebral magnetic resonance imaging (MRI) 9 days after onset, revealed a disseminated lesion, suggesting ADEM. Pulse therapy with methylprednisolone at 30 mg/kg was performed for 3 days. However, its clinical efficacy was not marked. Therapy with immunoglobulin (IVIg) at 400 mg/kg/day was started 15 days after onset, and continued for 5 days. This markedly improved the consciousness level and muscle strength, and the infant was discharged without neurological sequelae. ADEM showed a monophasic course, and the infant's subsequent growth has been favorable. Altough the number of case reports is small, massive-IVIg therapy should be considered in patients with steroid-refractory ADEM, as demonstrated in this case study.
authors: Department of Pediatrics, Dokkyo Medical University School of Medicine, Tochigi, Japan. geo@dokkyomed.ac.jp.
authors: G
authors: G
authors: Imataka
authors: O
authors: O
authors: Arisaka
mesh_terms: D003587:Cytomegalovirus / Q000187:drug effects / Q000276:immunology*; D004673:Encephalomyelitis, Acute Disseminated / Q000276:immunology* / Q000378:metabolism / Q000628:therapy* / Q000821:virology; D006801:Humans; D007116:Immunization, Passive / Q000379:methods; D016756:Immunoglobulins, Intravenous / Q000276:immunology* / Q000627:therapeutic use*; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D013256:Steroids / Q000378:metabolism*
chemical_list: D016756:Immunoglobulins, Intravenous; D013256:Steroids