{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T21:59:50Z","timestamp":1773871190019,"version":"3.50.1"},"reference-count":8,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,8,27]],"date-time":"2021-08-27T00:00:00Z","timestamp":1630022400000},"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>We present a case of an immunocompromised systemic lupus erythematosus female patient admitted to our hospital for general impairment, monoparesis, and temporary cognitive disability. The case represented a significant diagnostic and therapeutic challenge primarily because of a wide range of differential diagnosis options (CNS lupus, ischemic cerebrovascular disease, viral meningoencephalitis, progressive multifocal leukoencephalopathy, limbic encephalitis, and acute disseminated encephalomyelitis\u2014ADEM). Brain MRI findings were compatible with ADEM, and microbiological tests showed a cytomegalovirus infection (CMV) which is rarely associated with ADEM despite the increasing number of immunocompromised patients prone to symptomatic CMV reactivation. Our patient was treated with intravenous methylprednisolone, immunoglobulin (IVIG), along with antiviral therapy resulting in a favorable therapeutic effect. In conclusion, only a few described ADEM cases have been associated with CMV, and none of them, to the best of our knowledge, in an immunocompromised patient. In this case, a multidisciplinary approach and broad diagnostic considerations were decisive for successful treatment and outcome.<\/jats:p>","DOI":"10.3390\/medicina57090882","type":"journal-article","created":{"date-parts":[[2021,8,30]],"date-time":"2021-08-30T22:49:51Z","timestamp":1630363791000},"page":"882","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Case of Acute Disseminated Encephalomyelitis Associated with Cytomegalovirus Reactivation in an Immunocompromised Systemic Lupus Erythematosus Patient"],"prefix":"10.3390","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8878-7164","authenticated-orcid":false,"given":"Mirela","family":"Pavicic Ivelja","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, University Hospital of Split, University of Split School of Medicine, Soltanska 1, 21 000 Split, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kresimir","family":"Dolic","sequence":"additional","affiliation":[{"name":"Department of Radiology, University Hospital of Split, University of Split School of Medicine, Spinciceva 1, 21 000 Split, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela","family":"Marasovic Krstulovic","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Clinical Immunology, University Hospital of Split, University of Split School of Medicine, Soltanska 1, 21 000 Split, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gordana","family":"Glavina","sequence":"additional","affiliation":[{"name":"Department of Radiology, University Hospital of Split, University of Split School of Medicine, Spinciceva 1, 21 000 Split, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivo","family":"Ivic","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, University Hospital of Split, University of Split School of Medicine, Soltanska 1, 21 000 Split, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1177\/1352458510390068","article-title":"Disease course and outcome of acute disseminated encephalomyelitis is more severe in adults than in children","volume":"17","author":"Ketelslegers","year":"2011","journal-title":"Mult. Scler. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1016\/j.ncl.2008.03.009","article-title":"Acute disseminated encephalomyelitis: Clinical and pathogenesis features","volume":"26","author":"Noorbakhsh","year":"2008","journal-title":"Neurol. Clin."},{"key":"ref_3","first-page":"41","article-title":"A case of acute disseminated encephalomyelitis following Mycoplasma pneumoniae infection","volume":"12","author":"Laila","year":"2018","journal-title":"ID Cases"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.msard.2015.11.003","article-title":"An atypical case of acute disseminated encephalomyelitis associated with cytomegalovirus infection","volume":"5","author":"Modoni","year":"2016","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1177\/0961203314560426","article-title":"Simultaneous presentation of acute disseminated encephalomyelitis (ADEM) and systemic lupus erythematosus (SLE) after enteroviral infection: Can ADEM present as the first manifestation of SLE?","volume":"24","author":"Kim","year":"2015","journal-title":"Lupus"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Daida, K., Ishiguro, Y., Eguchi, H., Machida, Y., Hattori, N., and Miwa, H. (2016). Cytomegalovirus-associated encephalomyelitis in an immunocompetent adult: A two-stage attack of direct viral and delayed immune-mediated invasions. case report. BMC Neurol., 16.","DOI":"10.1186\/s12883-016-0761-6"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.jns.2016.03.015","article-title":"Life-threatening ADEM in an immunocompetent pregnant woman with concomitant asymptomatic Cytomegalovirus infection","volume":"364","author":"Macerollo","year":"2016","journal-title":"J. Neurol. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1097\/NRL.0b013e31813e34a5","article-title":"Limbic encephalitis and variants: Classification, diagnosis and treatment","volume":"13","author":"Dalmau","year":"2007","journal-title":"Neurologist"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/9\/882\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:53:09Z","timestamp":1760165589000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/9\/882"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,27]]},"references-count":8,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["medicina57090882"],"URL":"https:\/\/doi.org\/10.3390\/medicina57090882","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,27]]}}}