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Journal of the Korean Child Neurology Society 2008;16(2):222-228.
Published online November 30, 2008.
A Case of Acute Disseminated Encephalomyelitis Presenting with Bilateral Optic Neuritis associated with Mycoplasma pneumoniae.
Kyung Hye Keum, Kye Hyang Lee
Department of Pediatrics, College of Medicine, Daegu Catholic University, Daegu, Korea. rosalia@cu.ac.kr
Abstract
Mycoplasma pneumoniae(M. pneumoniae) is a well-known human respiratory pathogen. It also affects various organ systems and causes extrapulmonary complications, including neurologic, cutaneous, hematologic and ophthalmologic complications. M. pneumoniae has been implicated in a number of immune-mediated neurological diseases, such as ADEM, Gullian- Barre syndrome, and transverse myelitis. We present a 5-year-old boy with bilateral optic neuritis related to ADEM and pruritic skin lesions simultaneously associated with M. pneumoniae infection. He developed a headache with decreased activity six weeks before admission. He had no respiratory symptoms. Cerebral MRI showed multiple bilateral subcortical white matter lesions, suggesting a radiologic diagnosis of ADEM. M. pneumoniae was positive serologically. The cerebrospinal fluid polymerase chain reaction for M. pneumoniae was negative. The treatment with intravenous high-dose steroids and oral clarithromycin resulted in the rapid recovery of the patients visual and cutaneous problems. He was found to have returned to his normal conditions in the follow-up examination. We believe that immune-mediated injury can explain all the clinical manifestations of our case, which are ADEM-associated optic neuritis and cutaneous lesions.
Key Words: Optic neuritis, Acute disseminated encephalomyelitis, Mycoplasma pneumoniae, Skin manifestations


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