Batna Journal of Medical Sciences
Volume 13, Numéro 1, Pages 136-142
2026-05-01

Co-infections And Acute Disseminated Encephalomyelitis: A Case Report Of A Child In Batna, Algeria



Authors : Righi Nora . Rahmoune Loubna . Doumandji Melissa . Slimani Samy . Sobace Chantal . Mekki Yahia . Floret Daniel . Lina Bruno .

Abstract

Acute disseminated encephalomyelitis (ADEM) is an inflammatory, autoimmune demyelinating disease of the central nervous system (CNS), predominantly affecting the white matter. It typically follows a viral infection or vaccination, though idiopathic forms also occur. ADEM is rare but not exceptional in children. Between April 1, 2012, and August 31, 2015, we conducted a prospective, longitudinal, exhaustive cohort study involving patients older than 28 days presenting with clinical features suggestive of HIV-negative encephalitis or meningoencephalitis, meeting SPILF inclusion and exclusion criteria, and admitted in three departments (intensive care, infectious diseases, and pediatrics) of a tertiary hospital in Batna, Algeria. Among the 141 cases identified, 38 were children (27%). From this cohort, we report a particularly severe pediatric case of monophasic ADEM in a 12-year-old boy with documented exposure to four infectious agents. The patient presented with a 7-day history of febrile meningoencephalitis, altered consciousness, and seizures. MRI revealed bilateral fronto-parietal demyelinating lesions with supra- and infratentorial and medullary involvement. Blood PCR was positive for adenovirus and parvovirus B19, a pharyngeal swab was positive for a coronavirus, and serum IgM was reactive for Borrelia burgdorferi. CSF was acellular and sterile. Despite empirical broad-spectrum anti-infective treatment and high-dose corticosteroids, the patient developed deep coma, progressed to quadriplegia, severe respiratory distress, and required prolonged intensive care, and eventually died 7 years and 8 months later from chronic respiratory complications unrelated to a new demyelinating episode. This case highlights the diagnostic and therapeutic challenges in severe pediatric ADEM, particularly when multiple infectious triggers are identified. It also underscores the importance of distinguishing causative agents from incidental or sequential infections and the difficulty of establishing causality in complex co-infection scenarios.

Keywords

ADEM ; encephalitis ; co-infections ; demyelination ; parvovirus B19

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