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Acute disseminated encephalomyelitis following filarial infection
  1. Vimal K Paliwal1,
  2. G Goel1,
  3. R Vema2,
  4. S Pradhan1,
  5. R K Gupta3
  1. 1Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
  2. 2Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
  3. 3Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
  1. Correspondence to Dr Vimal K Paliwal, Assistant Professor, Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India; dr_vimalkpaliwal{at}rediffmail.com

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Introduction

Acute disseminated encephalomyelitis (ADEM) is thought to be an autoimmune inflammatory demyelinating disorder of the central nervous system (CNS) that occurs within weeks of a preceding viral illness, vaccination or, rarely, a bacterial infection. ADEM is less well known after a helminth infection and, in fact, filarial infection is known to provide protection against demyelinating CNS disease like multiple sclerosis.1 We present a patient who developed ADEM following acute filarial infection of the left arm. We also discuss the possible immunological mechanisms that led to ADEM following an acute filarial infection in our patient.

Case report

A 38-year-old man had acute onset weakness of left upper and lower limbs that progressed over the next 2–3 days resulting in loss of ambulation. There was no associated headache, vomiting, fever or seizures. Two months ago, the patient had developed acute painful swelling of his left arm with redness of overlying skin in the axilla and medial upper arm along with fever that lasted for 7 days. Gradually, his arm swelling and pain reduced after taking self-administered anti-inflammatory drugs. Several painless beaded swellings remained in the medial aspect of his left upper arm. On examination, there was a tense, warm, round, non-tender swelling of 3 cm diameter in the medial left arm with normal overlying …

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