Acute disseminated encephalomyelitis (ADEM) is an uncommon diagnosis in adults. It is known to be due to an abnormal immune response to a systemic infection rather than direct viral invasion to the central nervous system. There have been few reports of ADEM diagnosed in the setting of COVID-19 systemic infection. However, we report a case of Coxsackie induced ADEM that remitted but got exacerbated by COVID-19 infection. The patient contracted the COVID-19 infection shortly after being discharged to a rehabilitation facility. Direct COVID-19 neuroinvasion was ruled out via CSF PCR testing for the virus. The patient responded well to pulse steroid therapy and plasmapheresis in both occasions. We hypothesize that COVID-19 infection can flare-up a recently remitted ADEM via altering the immune responses. It is known now that COVID-19 infection can produce cytokine storming. Cytokine pathway activation is known to be involved in the pathology of ADEM. Caution regarding discharging immune suppressed patient to the inpatient rehabilitation facility should be made in the era of COVID-19 pandemic.

中文翻译：

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Covid-19 全身感染加剧了先前存在的急性播散性脑脊髓炎 (ADEM)

急性播散性脑脊髓炎 (ADEM) 在成人中是一种罕见的诊断。众所周知，这是由于对全身感染的异常免疫反应，而不是病毒直接侵入中枢神经系统。在 COVID-19 全身感染的情况下诊断出 ADEM 的报道很少。然而，我们报告了一例柯萨奇诱发的 ADEM，该病例缓解但因 COVID-19 感染而加剧。患者出院后不久就感染了 COVID-19。通过对病毒的 CSF PCR 检测排除了直接的 COVID-19 神经侵袭。在这两种情况下，患者对脉冲类固醇治疗和血浆置换反应良好。我们假设 COVID-19 感染可以通过改变免疫反应来引发最近缓解的 ADEM。现在已知，COVID-19 感染会产生细胞因子风暴。已知细胞因子途径激活参与 ADEM 的病理学。在 COVID-19 大流行时代，应注意将免疫抑制患者转至住院康复机构。