Adult-Onset Acute Disseminated Encephalomyelitis in Elderly Filipino Patients: A Case Report and Review of the Literature

Acute disseminated encephalomyelitis (ADEM) is an autoimmune disease characterized by inflammation of the cerebral hemispheres, brainstem, cerebellum, and spinal cord, often preceded by prodromal infections or vaccinations. The mainstay of treatment is immunosuppression with high-dose steroid therapy, intravenous immunoglobulin (IVIg), or plasma exchange (PE). While most pediatric patients improve with treatment, the prognosis in adults is less favorable. Local studies reporting the epidemiology, prevalence, incidence, treatment outcomes, and prognosis of ADEM are scarce. This case series presents two elderly Filipino female patients diagnosed with adult-onset ADEM who were treated with high-dose steroid therapy, IVIg, and PE. However, both patients experienced disease progression and eventually succumbed five months after the onset of illness. This study also highlights the diagnostic dilemma that clinicians may face when diagnosing ADEM in the elderly population, along with the treatment challenges and clinical outcomes in patients with a progressive disease course.