Acute disseminated encephalomyelitis associated with poliomyelitis vaccine

A 6-year-old female patient with acute disseminated encephalomyelitis assoc iated with poliomyelitis vaccine virus is reported, She had a history of hi gh fever, headache, and gait disturbance, Neurologic examination confirmed spastic triparesis, urinary incontinence, diminution of tactile sensation, and vision deterioration. Hemography, serum laboratory findings, and urinal ysis were normal. The cerebrospinal fluid was clear, with normal pressure, 9 leukocytes/mm(3), and 27 mg/dL protein, hut the myelin basic protein was elevated to 10.7 ng/mL. T-2-weighted magnetic resonance imaging disclosed m ultifocal high-intensity lesions of the spinal cord. The serum polio virus type 2 antibody titer was raised in the acute phase, and polio vaccine viru s type 2 was detected in viral cultures of the cerebrospinal fluid and phar ynx swab and had undergone an h-G neurovirulence mutation at nucleotide 481 . Finally, she had human leukocyte antigen (HLA)-Cw3 and HLA-DR2, to which multiple sclerosis is related in Japan, Thus the cause of ADEM may have bee n related to her Ill,A type. (C) 2000 by Elsevier science Inc. All rights r eserved.