Mumps is an acute communicable self‐limiting swelling of the parotid or other salivary glands. Various organs can be involved including the testes, central nervous system, mammary glands, ovary, pancreas, kidneys, and heart. We hereby present a rare case of an 18‐year‐old unvaccinated male with acute disseminated encephalomyelitis following mumps without parotitis.
Introduction:
Mumps, a paramyxovirus, commonly infects the salivary glands and the testes. Neurologic complications are documented with aseptic meningitis being the most common neurologic complication.[1] Other central nervous system (CNS) manifestations include cranial nerve palsies, cerebellar ataxia, transverse myelitis, Guillain‐Barré syndrome (GBS), and behavioral changes.[2] Acute disseminated encephalomyelitis (ADEM) following mumps without parotitis is an uncommon presentation.
Case:
An 18‐year‐old man presented with complaints of fever for 3 days, which was high grade, continuous in nature, and not associated with chills and rigor. The patient developed altered sensorium 1 day prior to admission. There was no significant medical or surgical history. There was no history of any vaccination in childhood or in recent past. On examination, he was unconscious with Glasgow Coma Scale (GCS) score of E4V1M4. His core temperature was 100°F. The blood pressure and pulse rate were 110/80 mmHg and 82 beats/minute, respectively. CNS examination revealed spastic tone along with bilateral positive Babinski sign. Meningeal signs were positive, and no cranial nerve involvement was seen. Rest of the general physical and systemic examination did not reveal any abnormality.
Laboratory investigations revealed blood count, liver function tests, and renal function tests were all within normal limits. Tests for viral hepatitis, malaria serology, and HIV were negative. Dengue serology and chikungunya serology were negative. Noncontrast computed tomography of head was normal. Cerebrospinal fluid (CSF) examination revealed total leukocyte count of two cells with protein 49 mg/dL and sugar 59 mg/dL. Mumps serology [immunoglobulin M (IgM) antibodies by MAC ELISA; NIV, Pune] was positive, but IgG antibodies were absent. Serology and CSF polymerase chain reaction for Epstein–Barr virus, herpes simplex virus 1, cytomegalovirus, herpes simplex virus 1, measles, and rubella were negative. CSF for oligoclonal bands and antiaquaporin‐4 antibodies were negative. CSF polymerase chain reaction for mumps was positive.
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