Acute Disseminated Encephalomyelitis Responsive to Cyclophosphamide Therapy: A Case Report

Acute disseminated encephalomyelitis (ADEM) is a rare neurologic condition that affects the central nervous system (CNS). In this report, a 22-year-old fraternal twin male developed ADEM 6 months post viral infection. He presented non-verbal with doll’s eyes, a right facial droop, right-sided upper and lower extremity weakness, as well as brisk reflexes and clonus on the right. He failed to improve with traditional therapies such as intravenous steroids, intravenous immunoglobulin, and plasmapheresis. However, 2 days following a 3-day course of intravenous cyclophosphamide 1,000 mg/m 2 , he spontaneously opened his eyes, developed masticatory movements, mouthed words, and regained movement in his extremities against gravity. There was a 40.7% and 16.6% decrease in lesion area in brain magnetic resonance imaging (MRI) T2 FLAIR sagittal and axial images, respectively over that 2-day period. This is the first reported case that shows neurological improvement, measured by the functional independence measure (FIM) scale, in addition to decreased lesion size on brain MRI T2 FLAIR images after implementation of cyclophosphamide therapy. Cyclophosphamide should be considered as an alternative therapy in patients with refractory ADEM. J Med Cases. 2015;6(7):290-294 doi: http://dx.doi.org/10.14740/jmc2176w