In Practice

Acute disseminated encephalomyelitis due to Rickettsia conorii infection

D Woolf, M Jordaan, G Maartens

Abstract


Acute disseminated encephalomyelitis (ADEM) is an immune-mediated acute inflammatory demyelinating disorder, which typically occurs after viral infections or immunisation. We present a case of a man with acute Rickettsia conorii infection whose diagnosis was delayed. He presented with fever, headache, an eschar and an acute paraplegia. The R. conorii IgM serum titre was 1:128. Magnetic resonance imaging showed multifocal lesions in the brain and spinal cord consistent with inflammatory demyelination. The patient responded well to doxycycline and a short course of high-dose corticosteroids. To our knowledge this is the first case of ADEM associated with Mediterranean spotted fever – we found a previous report of ADEM in a child with Rocky Mountain spotted fever, whose diagnosis of rickettsial infection was also delayed. We hypothesise that delayed diagnosis of spotted fever group rickettsial infections could rarely result in ADEM.


Authors' affiliations

D Woolf, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

M Jordaan, Morton and Partners, Cape Town, South Africa

G Maartens, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

Full Text

PDF (667KB)

Keywords

Rickettsia conorii; Acute disseminated encephalomyelitis; South Africa

Cite this article

South African Medical Journal 2021;111(4):307-308. DOI:10.7196/SAMJ.2021.v111i4.15308

Article History

Date submitted: 2021-03-31
Date published: 2021-03-31

Article Views

Abstract views: 1086
Full text views: 532

Comments on this article

*Read our policy for posting comments here