Dados do Trabalho
INFLAMMATORY BOWEL DISEASE AND ACUTE DISSEMINATED ENCEPHALOMYELITIS (ADEM): EXTRAINTESTINAL MANIFESTATION WITH TYPICAL CHANGES IN THE CENTRAL NERVOUS SYSTEM
Apresentação do caso
Girl, 11 years old, previously healthy, observed abdominal pain, weight loss, nausea and vomit. During in-hospital investigation, diagnosed inflammatory bowel disease, Crohn's disease. In this same hospitalization, observed severe and progressive headache persistent for fifteen days, evolved with ataxia and dysarthria lasting forty-eight hours, with rapid improvement after use of corticosteroids to treat the gastrointestinal pathology. Cerebrospinal fluid puncture was performed without alterations, although magnetic resonance imaging of the brain evidenced areas of hypersignal alteration affecting white matter, with cerebellar and cerebral cortical involvement, justifying neurological findings.
Inflammatory bowel diseases are chronic inflammatory condition that affects the digestive system and evolves in different ways through the gastrointestinal mucosa. Crohn's disease is characterized by ulcers that can involves transmurally any segment of the digestive tract, from mouth to anus. Besides gastrointestinal involvement, extraintestinal manifestations are common complaints of some patients; mouth, eyes, skin or the central and nervous system can be affected.
Neurological involvement appears to occur rarely, however prevalence and incidence data are not available due to, because systematic studies are lacking. Demyelinating disorders are known to be related with inflammatory bowel diseases, as a disease association, similar behavior (disease like) or triggered by drug therapy. Manifestations as headache, paresthesia, dysarthria or aphasia, hyperreflexia are some of the referred complaints. In addition to symptomatology compatible with demyelination, the imaging findings corroborate the involvement of the central nervous system.
In this case report, gastrointestinal and neurological manifestations were observed during diagnostic investigation, favoring clinical correlation. In addition, image particularities approximate the diagnosis for ADEM or ADEM like, after targeted therapy beginning, which seems to be more usual.
Considering the scarcity of specific data on neurological disorders associated with inflammatory bowel diseases, the reported case corroborates such evidence and reiterates the relevance of care shared between neurology and gastroenterology to establish the best therapeutic choice in these cases.
Referências (se houver)
Ferro JM, Oliveira Santos M. Neurology of inflammatory bowel disease. J Neurol Sci. 2021 May 15;424:117426. doi: 10.1016/j.jns.2021.117426. Epub 2021 Mar 27. PMID: 33810878.
Scheid R, Teich N. Neurologic manifestations of ulcerative colitis. Eur J Neurol. 2007 May;14(5):483-93. doi: 10.1111/j.1468-1331.2007.01718.x. PMID: 17437605.
Inflammatory bowel disease; Demyelinating; Acute Disseminated Encephalomyelitis
Fonte de Fomento (se houver)
Declaração de conflito de interesses de TODOS os autores
Não há conflito de interesses
Neuroimunologia, esclerose múltipla e outras doenças desmielinizantes
Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo (HCRP) - São Paulo - Brasil
Laura Defensor Ribeiro Melo, Taynara Montes Araujo Cascão Figueiredo, Roberta Fantauzzi Borges, Matheus Souza Rosa, Eduardo Vaz de Sousa Ferreira, Amanda Povoa Paiva, Maria Avanise Yumi Minami, Ana Paula Andrade Hamad