Volume 92, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



We present the first report of a pediatric case of acute disseminated encephalomyelitis (ADEM) associated with Madariaga virus infection (MADV, , Togaviridae; formerly known as South American variants of eastern equine encephalitis virus [EEEV]) in a patient of the 2010 alphaviral epidemic reported in Panama. The patient was admitted to the Hospital del Niño in Panama City with suspected meningitis, exhibited with decreased alertness and disorientation in space and time, hemiparesis, and left Babinski sign. The patient was transferred to the intensive care unit and treated with aciclovir and methylprednisolone. The magnetic resonance imaging (MRI) of the brain revealed multiple hyperintense lesions at T-weighted images (T2) and fluid-attenuated inversion recovery (FLAIR) on the cortical–subcortical level. Sera samples obtained on days 6 and 12 were immunoglobulin M (IgM) positive for MADV. The findings on the clinical and cerebrospinal analyses, rapid symptom progression as well as neuroimaging, and serologic studies support our diagnosis. Our results suggest that MADV should be included in the etiologic differential diagnosis of ADEM in endemic countries.


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  1. Carrera JP, Forrester N, Wang E, Vittor AY, Haddow AD, Lopez-Verges S, Abadía I, Castaño E, Sosa N, Báez C, Estripeaut D, Díaz Y, Beltrán D, Cisneros J, Cedeño HG, Travassos da Rosa AP, Hernandez H, Martínez-Torres AO, Tesh RB, Weaver SC, , 2013. Eastern equine encephalitis in Latin America. N Engl J Med 369: 732744.[Crossref] [Google Scholar]
  2. Arrigo NC, Adams AP, Weaver SC, , 2010. Evolutionary patterns of eastern equine encephalitis virus in North versus South America suggest ecological differences and taxonomic revision. J Virol 84: 10141025.[Crossref] [Google Scholar]
  3. Tenembaum S, Chitnis T, Ness J, Hahn JS, the International Pediatric MS Study Group, , 2007. Acute disseminated encephalomyelitis. Neurology 68 (Suppl 2): S23S36.[Crossref] [Google Scholar]
  4. Tenembaum S, Chamoles N, Fejerman N, , 2002. Acute disseminated encephalomyelitis: a long-term follow-up study of 84 pediatric patients. Neurology 59: 12241231.[Crossref] [Google Scholar]
  5. Beaty BJ, Calisher CH, Shope RE, Lennette EH, Lennette DA, Lennette ET, , 1995. Diagnostic procedures for viral, rickettsial and chlamydial infections. , eds. Arboviruses. Washington, DC: American Public Health Association, 189212. [Google Scholar]
  6. Menge T, Hemmer B, Nessler S, Wiendl H, Neuhaus O, Hartung HP, Kieseier BC, Stüve O, , 2005. Acute disseminated encephalomyelitis: an update. Arch Neurol 62: 16731680.[Crossref] [Google Scholar]
  7. Murthy SN, Faden HS, Cohen ME, Bakshi R, , 2002. Acute disseminated encephalomyelitis in children. Pediatrics 110: e21.[Crossref] [Google Scholar]
  8. Deresiewicz RL, Thaler SJ, Hsu L, Zamani AA, , 1997. Clinical and neuroradiograph manifestations of eastern equine encephalitis. N Engl J Med 336: 18671874.[Crossref] [Google Scholar]
  9. Erazo-Torricelli R, , 2006. Acute disseminated encephalomyelitis in children. Rev Neurol 42 (Suppl 3): S75S82. [Google Scholar]
  10. Krupp LB, Banwell B, Tenembaum S, the International Pediatric MS Study Group, , 2007. Consensus definitions proposed for pediatric multiple sclerosis and related disorders. Neurology 68 (Suppl 2): S7S12.[Crossref] [Google Scholar]
  11. Khor CC, Bich CTN, Pang J, Davila S, Long HT, Ong RT, Dunstan SJ, Wills B, Farrar J, Van Tram T, Gan TT, Binh NT, Tri le T, Lien le B, Tuan NM, Tham NT, Lanh MN, Nguyet NM, Hieu NT, Van N, Vinh Chau N, Thuy TT, Tan DE, Sakuntabhai A, Teo YY, Hibberd ML, Simmons CP, , 2011. Genome-wide association study identifies susceptibility loci for dengue shock syndrome at MICB and PLCE1 . Nat Genet 43: 11391141.[Crossref] [Google Scholar]
  12. Imataka S, Arisaka O, , 2014. An infant with steroid refractory cytomegalovirus-associated ADEM who responded to inmunoglobulin therapy. Eur Review Med Pharmacol Sci 18: 21482151. [Google Scholar]
  13. Erol I, Ozkale Y, Alkan O, Alehan F, , 2013. Acute disseminated encephalomyelitis in children and adolescents: a single center experience. Pediatr Neurol 49: 266273.[Crossref] [Google Scholar]

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  • Received : 31 Dec 2014
  • Accepted : 04 Mar 2015
  • Published online : 03 Jun 2015

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