Acute disseminated encephalomyelitis following human papillomavirus vaccination in an adult woman: A case report

Peddada ASS, Vutlapalli N, Kanugula S

Pdf Page Numbers :- 78-82

Anantha Sai Siddhardh Peddada^1,*, Niteesh Vutlapalli² and Shivaraju Kanugula³

¹Department of General Medicine, Krishna Institute of Medical Sciences, Minister Road, Secunderabad-500003, Telangana, India

*Corresponding author: Dr. K. Shiva Raju, Department of Internal Medicine, Krishna Institute of Medical Sciences, Minister Road, Secunderabad-500003, Telangana, India. Email: shivaraju.doctor@gmail.com

Received 6 January 2026; Revised 17 March 2026; Accepted 23 March 2026; Published 30 March 2026

Citation: Peddada ASS, Vutlapalli N, Kanugula S. Acute disseminated encephalomyelitis following human papillomavirus vaccination in an adult woman: A case report. J Med Sci Res. 2026; 14(2):78-82. DOI: http://dx.doi.org/10.17727/JMSR.2026/14-15

Copyright: © 2026 Peddada ASS et al. Published by KIMS Foundation and Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Acute disseminated encephalomyelitis (ADEM) is an acute, immune-mediated inflammatory demyelinating disorder of the central nervous system characterised by encephalopathy and multifocal neurological involvement. Although it predominantly affects children, it can also occur in adults and may follow an infection or, less commonly, immunisation. We report the case of a 26-year-old woman with no significant medical history who developed fever and headache within 6 hours of receiving the Gardasil 9 human papillomavirus (HPV) vaccine. Initial investigations, including routine laboratory tests and non-contrast brain magnetic resonance imaging (MRI), were unremarkable. Despite symptomatic treatment, she subsequently developed tongue numbness, speech difficulty, irritability, and altered sensorium. Cerebrospinal fluid examination demonstrated lymphocytic pleocytosis and elevated protein, while microbiological and molecular investigations were negative. Contrast-enhanced brain MRI showed diffuse leptomeningeal enhancement, and brain fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) demonstrated multifocal metabolic abnormalities interpreted as suggestive of an autoimmune inflammatory process. In the clinical context, after exclusion of infectious causes and other relevant autoimmune disorders, post-vaccination ADEM was considered. She received intravenous methylprednisolone pulse therapy for 5 days, with rapid clinical improvement, and was discharged on an oral steroid taper. This case highlights the importance of considering ADEM in adults who develop acute encephalopathy and multifocal neurological manifestations following immunisation, while emphasising that a temporal association does not by itself establish causality.

Keywords: acute disseminated encephalomyelitis; human papillomavirus vaccine; Gardasil 9; encephalopathy; demyelinating disorder; immunisation