Fulminant Acute Disseminated Encephalomyelitis in An Adult: A Case Report and Review of Literature

Acute disseminated encephalomyelitis (ADEM) is an acquired autoimmune disease that results in demyelination of the central nervous system.The condition is predominantly a childhood illness precipitated by vaccines or infections.However, it can occur in adults and is associated with worse prognosis.Here, we describe an adult patient who was initially diagnosed with a psychiatric illness, but had rapidly progressive neurological deterioration, which led to investigation of other causes.MRI brain was also progressively worsening and showed extensive tumefactive process.The atypical onset of age, fulminant progression (clinically and radiologically) and absence of typical preceding inciting event posed uncertainty in diagnosis.Nevertheless, ruling out most causes and considering autoimmune inflammation as likely pathophysiology, all tiers of immunomodulatory therapy were tried.Treatment failed to hasten recovery, but ultimately there was some improvement with residual neurological deficits.Alternatively, a diagnosis of Marburg disease, a fulminant type of multiple sclerosis (MS) was also considered.Only time will tell whether the process is monophasic (ADEM) or will there be relapses and recurrences (MS) to clearly distinguish between these two.