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.