ADEM From Rabies Vaccine:a Case Report And Review Of The Literature

Objective:To investigate the clinical characteristics and the experience in diagnosis and treatment of ADEM, analyze the relations of rabies vaccine and ADEM, discuss the preventions of post-vaccine encephalomyelitis.Methods:A medical record about acute disseminated encephalomyelitis from rabies vaccine was analyzed retrospective and the literature was reviewed.Design:Case report and literature review.Patient:The patient was injected rabies vaccine due to dog bites one month before admission, and felt headache and body aches after the three days of the fourth injection needle(seven days before admission). The patient felt fever and slurred speech three days before admission. Lumbar puncture showed virus infection changes, The brain MR scan showed the long T1, T2lesions located on the left thalamus.Intervention:The patient was given intravenous methylprednisolone and immunoglobulin pulse therapy, supplemented by scavenging oxygen free radicals, improving circulation, trophic nerve, tracheostomy ventilation and nutritional support and symptomatic treatment.Results:At last, The patient’s condition progressively worsened, although the patient out of danger after active emergency treatment, but he had remained severe neurological deficits.Conclusion:For the patient who had a vaccination history before, acute or sub-acute onset in clinical manifestation, and had multifocal central nervous system defects, should be highly suspected the possible of acute disseminated encephalomyelitis, Treatment of ADEM should use large doses of glucocorticoid, immunoglobulin early, and prevent the complications and promote the recovery of neurological function to improve the prognosis. Through literature, correlation was seen between inoculated rabies vaccine and ADEM, and the obvious dose-response relationship between them, and ADEM more easily appear after the fourth injection needle, we also can learn that adults are more likely to cause ADEM than children after vaccination. Using the WHO-recommended Zagreb immunization program, can reduce the incidence of ADEM...