P007 - A case of acute disseminated encephalomyelitis mimicking multiple sclerosis attack treated by plasmapheresis

Abstract

Acute disseminated encephalomyelitis (ADEM) is an acute multifocal demyelinating disease of the central nervous system. Its clinical course in most cases is monophasic; however, relapsing ADEM is rarely seen, which poses a diagnostic challenge for distinguishing this disease from multiple sclerosis (MS). The common treatment approach in ADEM consists of high daily doses of intravenous methylprednisolone for 3–5 days, followed by an oral corticosteroid taper. However, some patients with ADEM are refractory to steroid therapy. In case of insufficient response to corticosteroids, intravenous immunoglobulin G is a therapeutic option. Plasmapheresis might be an effective treatment and life-saving in cases of fulminant ADEM. We report a case of a 22-year-old man admitted to our clinic as a MS attack but lately suffering from fulminant ADEM. The patient did not respond to corticosteroid therapy but exhibited a dramatic recovery with plasmapheresis. Effectiveness of plasmapheresis has been demonstrated by previous case reports. For severe or life-threatening cases of ADEM, plasmapheresis should be considered early in the disease course. Acute disseminated encephalomyelitis (ADEM) is an acute multifocal demyelinating disease of the central nervous system. Its clinical course in most cases is monophasic; however, relapsing ADEM is rarely seen, which poses a diagnostic challenge for distinguishing this disease from multiple sclerosis (MS). The common treatment approach in ADEM consists of high daily doses of intravenous methylprednisolone for 3–5 days, followed by an oral corticosteroid taper. However, some patients with ADEM are refractory to steroid therapy. In case of insufficient response to corticosteroids, intravenous immunoglobulin G is a therapeutic option. Plasmapheresis might be an effective treatment and life-saving in cases of fulminant ADEM. We report a case of a 22-year-old man admitted to our clinic as a MS attack but lately suffering from fulminant ADEM. The patient did not respond to corticosteroid therapy but exhibited a dramatic recovery with plasmapheresis. Effectiveness of plasmapheresis has been demonstrated by previous case reports. For severe or life-threatening cases of ADEM, plasmapheresis should be considered early in the disease course.