Cytotoxic Lesion of the Corpus Callosum in an Adolescent with Multisystem Inflammatory Syndrome and SARS-CoV-2 Infection

Abstract

Multisystem inflammatory syndrome in children is a recently described complication in the late phase of Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection involving systemic hyperinflammation and multiorgan dysfunction. The extent of its clinical picture is actively evolving and has yet to be fully elucidated. While neurologic manifestations of SARS-CoV-2 are well-described in the adult population, reports of neurologic complications in pediatric patients with SARS-CoV-2 infection are limited. We present a pediatric patient with SARS-CoV-2 infection with development of multisystem inflammatory syndrome and acute encephalopathy causing delirium who was found to have a cytotoxic lesion of the corpus callosum on neuroimaging. Cytotoxic lesions of the corpus callosum are a well-known, typically reversible entity that can occur in a wide range of conditions, including infection, seizure, toxins, nutritional deficiencies, and Kawasaki disease. We hypothesized that the cytotoxic lesion of the corpus callosum, in the index case, was secondary to the systemic inflammation from SARS-CoV-2 infection, resulting in multisystem inflammatory syndrome in children.

FIGURE.

CLOCC in an adolescent with MIS-C and SARS-CoV-2.. MR image of the brain demonstrates a nonspecific focus of increased signal in the splenium of the corpus callosum on DWI sequences at b=1000 s/mm² (black arrow, A) with associated loss of signal on apparent diffusion coefficient maps (white arrow, B) corresponding to restricted diffusion. The apparent diffusion coefficient for the lesion is 0.44 × 10⁻³mm²/s. This lesion corresponds to a faint focus of abnormal increased signal on T2WI spin-echo sequences (black arrowhead, C). The lesion also demonstrates a lack of contrast enhancement on T1WI postcontrast thin-section image (D) and absent susceptibility, suggesting absent hemorrhage on SWI (E). The imaging findings suggest a cytotoxic lesion of the corpus callosum. Follow-up DWI (F) and ADC maps (G) with T2WI (H), T1WI (I), and SWI sequences (J) after 2.5 months demonstrate resolution of the lesion after therapy.