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She deteriorated with encephalopathy and respiratory failure, requiring intubation. MRI revealed extensive brain and spinal demyelination. Infectious, autoimmune and paraneoplastic investigations were negative, while serology revealed markedly elevated spotted fever group antibodies. Treatment with high-dose corticosteroids and plasma exchange therapy resulted in significant neurological recovery. She was discharged after rehabilitation with a good recovery at 70%\u201380% of pre-morbid function. This case supports a possible post-infectious immune-mediated mechanism linking rickettsia and ADEM and underscores the importance of early recognition and treatment of ADEM.<\/jats:p>","DOI":"10.1136\/bcr-2025-268335","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T12:05:13Z","timestamp":1785758713000},"page":"e268335","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Treatment of acute demyelinating encephalomyelitis associated with recent rickettsial infection"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-3160-2223","authenticated-orcid":false,"given":"Michael Christopher","family":"Dowe","sequence":"first","affiliation":[{"name":"Intensive Care, Eastern Health, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tushar","family":"Goyal","sequence":"additional","affiliation":[{"name":"Medicine, Eastern Health, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"2026080305050494000_19.8.e268335.1","doi-asserted-by":"crossref","unstructured":"Tenembaum S , Chitnis T , Ness J , et al . 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