{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T12:46:21Z","timestamp":1793018781429,"version":"4.5.0"},"reference-count":18,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2020,6,4]],"date-time":"2020-06-04T00:00:00Z","timestamp":1591228800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Autoimmune pathology of acute disseminated encephalomyelitis (ADEM) is generally restricted to the brain. Our objective is to expand the phenotype of ADEM. A four-year-old girl was admitted to the pediatric emergency room of a university medical center five days after a common upper respiratory tract infection. Acute symptoms were fever, leg pain, and headaches. She developed meningeal signs, and her level of consciousness dropped rapidly. Epileptic seizure activity started, and she became comatose, requiring intubation and mechanical ventilation. Serial brain magnetic resonance imaging (MRI) illustrated the fulminant development of ADEM. Treatment escalation with high-dose corticosteroids, immunoglobulins, and plasma exchange did not lead to clinical improvement. On day ten, the patient developed treatment-refractory cardiogenic shock and passed away. The postmortem assessment confirmed ADEM and revealed acute lymphocytic myocarditis, likely explaining the acute cardiac failure. Human metapneumovirus and picornavirus were detected in the tracheal secrete by PCR. Data sources\u2013medical chart of the patient. This case is consistent with evidence from experimental findings of an association of ADEM with myocarditis as a postinfectious systemic autoimmune response, with life-threatening involvement of the brain and heart.<\/jats:p>","DOI":"10.3390\/medicina56060277","type":"journal-article","created":{"date-parts":[[2020,6,5]],"date-time":"2020-06-05T03:32:21Z","timestamp":1591327941000},"page":"277","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Acute Disseminated Encephalomyelitis with Seizures and Myocarditis: A Fatal Triad"],"prefix":"10.3390","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1320-163X","authenticated-orcid":false,"given":"Hanne","family":"Lademann","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Interdisciplinary Pediatric Intensive Care Medicine, University Medical Center Rostock, 18057 Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2832-0156","authenticated-orcid":false,"given":"Astrid","family":"Bertsche","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Neuropediatrics, University Medical Center Rostock, 18057 Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Petzold","sequence":"additional","affiliation":[{"name":"Department of Neuroimmunology, The National Hospital for Neurology and Neurosurgery, Queen Square, UCL Institute of Neurology, London WC1N 3BG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fred","family":"Zack","sequence":"additional","affiliation":[{"name":"Institute of Legal Medicine, University Medical Center Rostock, 18055 Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6676-4957","authenticated-orcid":false,"given":"Andreas","family":"B\u00fcttner","sequence":"additional","affiliation":[{"name":"Institute of Legal Medicine, University Medical Center Rostock, 18055 Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4219-5283","authenticated-orcid":false,"given":"Jan","family":"D\u00e4britz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Medical Center Rostock, 18057 Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Hauenstein","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Interventional Radiology, University Medical Center Rostock, 18057 Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Bahn","sequence":"additional","affiliation":[{"name":"Institute of Neuropathology, University Medical Center G\u00f6ttingen, 37073 G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Spang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, Interdisciplinary Pediatric Intensive Care Medicine, University Medical Center Rostock, 18057 Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Reuter","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, Interdisciplinary Pediatric Intensive Care Medicine, University Medical Center Rostock, 18057 Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Warnke","sequence":"additional","affiliation":[{"name":"Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Rostock, 18057 Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7866-9781","authenticated-orcid":false,"given":"Johannes","family":"Ehler","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, Interdisciplinary Pediatric Intensive Care Medicine, University Medical Center Rostock, 18057 Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,6,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2407","DOI":"10.1093\/brain\/123.12.2407","article-title":"Acute disseminated encephalomyelitis, multiphasic disseminated encephalomyelitis and multiple sclerosis in children","volume":"123","author":"Dale","year":"2000","journal-title":"Brain"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.1177\/1352458509348518","article-title":"Transient cardiomyopathy as the presenting feature of acute disseminated encephalomyelitis","volume":"15","author":"Mawhinney","year":"2009","journal-title":"Mult. 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