Disclosures: Adem F. Aktas, DO: No financial relationships or conflicts of interest

Case Description: 30-year-old male presented to ED with progressive symptoms of malaise, weakness, and slurring speech of 1-day duration. Vitals demonstrated fever, tachycardia, and tachypnea. Patient was not oriented and unresponsive. Exam demonstrated bilateral upper extremity flexion pattern. Brain MRI showed patchy white matter lesions with mild enhancement suggestive of acute disseminated encephalomyelitis (ADEM). Treated with plasmapheresis, methylprednisone and Cytoxin. Hospital course significant for autonomic storming and agitation. Patient’s neurologic state improved and was transferred to inpatient rehabilitation for continued medical care.

Setting: Tertiary care academic hospital.

Patient: 30-year-old male with no medical history. Vaping of 1-month duration. Assessment/

Results: Workup was negative for an infectious or rheumatologic etiology. During ICU course, patient was treated with plasmapheresis, intravenous methylprednisone as well as cytoxin. After extubation, patient followed 1 step commands and oriented to self. Motor strength left and right upper extremity 3/5 and bilateral lower extremity 1/5. PM&R managed autonomic storming and agitation on a scheduled regimen of bromocriptine, propranolol and clonidine. Patient was transferred to inpatient rehabilitation and eventually discharged home with follow up.

Discussion: ADEM is an acute, autoimmune, demyelinating disease of the CNS known to predominantly affect the white matter tracts of the brain and spinal cord. The pathogenesis is thought to occur secondary to molecular mimicry and most commonly occurs following an infection or vaccination. Symptoms are often multifocal and rapidly progressive requiring hospitalization; Neuroimaging is critical in establishing a diagnosis with MRI findings of multiple large asymmetric lesions with patchy areas of signal intensity. Our patient had no antecedent febrile illness, respiratory infection, or vaccination to serve as a more likely cause of his ADEM.

Conclusion: This case demonstrates a unique etiology of a neurologic insult with a hospital course complicated by common issues such as autonomic storming and agitation. This case demonstrates the importance of longitudinal care with eventual plans for community re-integration.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/acute-disseminated-encephalomyelitis-secondary-to-vaping/