The recent article on acute demyelinating encephalomyelitis
in a patient with falciparum malaria is very interesting
[1]. Indeed, the neurological complication of falciparum
malaria is not uncommon but the acute demyelinating
encephalomyelitis is extremely rare. Recently, a similar
case was published in another journal [2]. It was proposed
that the pathophysiology is due to immunopathological
process [3]. The question is whether the acute demyelinating
encephalomyelitis is an exact neurological complication due
to falciparum malaria. In the present case, it is no doubt
that both malaria and acute demyelinating encephalomyelitis
existed. However, the question is whether this is an
accidental concomitant occurrence. Some viral infections
such as dengue are also endemic in the same setting as
malaria [4] and can be the cause of acute demyelinating
encephalomyelitis [5]. Since there is no laboratory test to
rule out concomitant viral infection, the conclusion can be
only detection of two disorders in the patient.
1. Agrawal A, Goyal S. Acute
demyelinating encephalomyelitis in a child following
malaria. Indian Pediatr. 2012;49:922-3.
2. Rachita S, Satyasundar M, Mrutunjaya
D, Birakishore R. Acute disseminated encephalomyelitis
(ADEM)-A rare complication of falciparum malaria. Indian J
Pediatr. 2012 Jun 15. [Epub ahead of print]
3. Dey AB, Trikha I, Banerjee M, Jain R,
Nagarkar KM. Acute disseminated encephalomyelitis—another
cause of post malaria cerebellar ataxia. J Assoc Physician
India. 2001;49:756-8.
4. Wiwanitkit V. The importance of
accurate diagnosis of dengue fever. Future Virol.
2012;1:53-62.
5. Brito CA, Sobreira S, Cordeiro MT, Lucena-Silva N.
Acute disseminated encephalomyelitis in classic dengue. Rev
Soc Bras Med Trop. 2007;40:236-8.