A child with difficulty swallowing.

Difficulty swallowing is a common presenting complaint among children seen in the emergency department. We report a case of a male child who presented with difficulty swallowing as the first manifestation of acute disseminated encephalomyelitis and review the pathogenesis and clinical manifestations of this disease. Acute disseminated encephalomyelitis is typically a monophasic, postinfectious, demyelinating disease that presents most often with encephalopathy and acute or subacute, multifocal neurologic deficits. The case demonstrates the importance of considering alternate diagnoses when presented with a patient having a common symptom for which evaluation does not provide a plausible cause.