Acute disseminated encephalomyelitis following intralesional MMR vaccination: A rare case report and mini review
Acute disseminated encephalomyelitis (ADEM) is a demyelinating, immune-mediated inflammatory condition of the central nervous system (CNS). It can affect individuals of all ages. The case definition for monophasic ADEM includes polyfocal clinical CNS events of inflammatory origin, with magnetic resonance imaging showing large (>1 cm) diffuse white matter lesions, absence of relapse for 3 months, and exclusion of other acute demyelinating disorders. ADEM can also be associated with various infections and vaccinations. Our case study suggests that ADEM occurs following intralesional measles, mumps, and rubella (MMR) vaccination to treat cutaneous warts. This case highlights the importance of making a well-informed decision regarding the risk of demyelinating disease in patients receiving vaccines. In addition, it emphasizes the need to obtain a detailed vaccination history when assessing patients with suspected ADEM. This is the first documented case of ADEM following intralesional MMR vaccination.
- Krupp LB, Tardieu M, Amato MP, et al. International pediatric multiple sclerosis study group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: Revisions to the 2007 definitions. Mult Scler. 2013;19(10):1261-1267. doi: 10.1177/1352458513484547
- Nishiyama M, Nagase H, Tomioka K, et al. Clinical time course of pediatric acute disseminated encephalomyelitis. Brain Dev. 2019;41:531‐537. doi: 10.1016/j.braindev.2019.02.011
- Bennetto L, Scolding N. Inflammatory/post‐infectious encephalomyelitis. J Neurol Neurosurg Psychiatry. 2004;75 Suppl 1:i22‐i28. doi: 10.1136/jnnp.2003.034256
- Kulkarni V, Nadgir D, Tapiawala S, et al. Biphasic demyelination of the nervous system following anti-rabies vaccination. Neurol India. 2004;52:106-108.
- Huynh W, Cordato DJ, Kehdi E, Masters LT, Dedousis C. Post‐vaccination encephalomyelitis: Literature review and illustrative case. J Clin Neurosci. 2008;15(12):1315‐1322. doi: 10.1016/j.jocn.2008.05.002
- Guliani G. Parry (Minneapolis, US). Multiple Sclerosis Triggered by Purified Chicken Embryo Cell Rabies Vaccine. In: 5th Joint Triennial Congress of the European and American Committees for Treatment and Research in Multiple Sclerosis Amsterdam, The Netherlands; 2011.
- Schwarz S, Mohr A, Knauth M, Wildemann B, Storch‐ Hagenlocher B. Acute disseminated encephalomyelitis: A follow‐up study of 40 adult patients. Neurology. 2001;56:1313‐1318. doi: 10.1212/wnl.56.10.1313
- Lazaro LG, Perea Cossio JE, Luis MB, et al. Acute disseminated encephalomyelitis following vaccination against SARS-CoV-2: A case report. Brain Behav Immun Health. 2022;20:100439. doi: 10.1016/j.bbih.2022.100439
- Otiv M, Botre A, Shah P. Measles-rubella vaccine-associated MOG-antibody positive acute demyelinating encephalomyelitis with optic neuritis in a child. Ther Adv Vaccines Immunother. 2022;10:25151355221115016. doi: 10.1177/25151355221115016
- Rossor T, Benetou C, Wright S, et al. Early predictors of epilepsy and subsequent relapse in children with acute disseminated encephalomyelitis. Mult Scler. 2020;26(3): 333-342. doi: 10.1177/1352458518823486