Improvement of advanced postvaccinal demyelinating encephalitis due to plasmapheresis

Andreas Rogalewski¹, Jörg Kraus³, Martin Hasselblatt², Christoffer Kraemer¹, Wolf-Rüdiger Schäbitz¹

¹Department of Neurology; ²Institute of Neuropathology, University of Muenster, Germany, ³Paracelsus Private Medical University and Salzburger Landesklinken, Christian-Doppler-Klinik, Department of Neurology, Salzburg, Austria

Abstract: We report a case of acute demyelinating encephalitis that occurred after viral vaccination against hepatitis A-, hepatitis B-, and poliovirus and vaccination against bacterial toxins of diphtheria and tetanus. After different diagnosis had been excluded, we diagnosed postvaccinal demyelinating encephalitis and started treatment with high dose intravenous methylprednisolone, followed by peroral application in decreasing dosages for three weeks. A few days after the treatment with methylprednisolone had been finished, the patient’s medical condition deteriorated again. Thus, we initiated plasma exchange at an advanced state of illness, which led to significant continuous improvement. The role of plasma exchange is discussed controversially, in particular the issue of timing. We report a case that shows improvement due to plasmapheresis several weeks after symptom onset.

Keywords: ADEM, vaccination, encephalitis, plasmapheresis, demyelination, plasma exchange