Encephalomyelitis by adenovirus

Case presentation: Three-year-old male admitted with aphasia and mental confusion that last 48 hours. Report a fever peak of 38°C. Vomiting hyaline rhinorrhea resolved four days ago. Plus diarrheal symptoms three weeks prior to hospitalization. He did not recognize his mother other family members, he was frightened by environmental stimuli, could walk, fell if placed standing sit without support. Previously healthy. History febrile seizures at 1 year age on sodium valproate. Proper motor development, but speech delay. Son healthy couple non-consanguineous from Manaus, attended day care good socialization. On examination awake disoriented, cranial nerves unaltered. presented traction the lower limbs flexion thigh painful stimuli spontaneous elevation against gravity, signs pyramidal release bilateral patellar areflexia. Lumbar puncture showed cellularity 27 predominance lymphocytes, protein 19, glucose 51and lactate 1.4. Normal metabolic tests tomography. Started acyclovir requested panel for viral meningitis in cerebrospinal fluid (CSF). The following day, progressed worsening, dysphagia loss head support, maintained limb areflexia, being referred ICU where received immunoglobulin. discharged after hours improvement. Ophthalmologic evaluation EEG were normal. Neuroaxis MRI symmetrical signal alteration posterior region brainstem, more evident bulb pontine insinuation dentate nucleus cerebellar hemispheres, anomalous contrast impregnation, suggesting or autoimmune etiology. Therefore, it chosen repeat lumbar normal CSF (4 cells). patient evolved recovery consciousness neurotendinous reflexes. positive PCR adenovirus. asymptomatic, discontinued.