Acute Disseminated Encephalomyelitis in A 4-Year-Old Female Treated for Cerebral Malaria: A Case Report

Abstract

Acute disseminated encephalomyelitis (ADEM) is a multifocal demyelinating disease and a rare post-malarial neurologic sequela. It usually follows cerebral malaria few days to weeks after full recovery and there is absence of malaria parasites in the patient’s peripheral blood film. It can also follow bacterial and viral illnesses. Malaria is an endemic disease in tropical countries like Nigeria, but with careful literature search, no reported case of ADEM following complicated malaria in Nigerian children was seen. Reported cases of post malaria ADEM from other malaria endemic countries were in older children and young adults. We report a case of ADEM in a 4year old female who presented to our centre with features of complicated malaria (cerebral malaria and black water fever). She was treated for complicated malaria and recovered fully. Few days’ post recovery, she suddenly developed diffuse neurologic symptoms with a CT scan result which suggested ADEM. There was no malaria parasite seen in a repeat peripheral blood film and cerebrospinal fluid analysis showed elevated protein and lymphocytic pleocytosis. With institution of steroid therapy, she recovered remarkably and was discharged home. This case demonstrates the need for a high index of suspicion, close monitoring and follow up of children treated for cerebral malaria as ADEM is a treatable post malarial complication, which if undetected, can lead to permanent neurologic sequelae.

Key words: Multifocal demyelinating disease, Neurologic sequelae, Non traumatic encephalopathy, Children.