The case of encephalitis in a COVID-19 pediatric patient

Abstract

Background: The COVID-19 pandemic, induced by the worldwide spreading of the SARS-CoV-2, is well known for its clinical picture consistent with respiratory symptoms. If pulmonary complications are the most common manifestation of the disease, neurological problems are also significantly present, with complications including acute cerebrovascular events, encephalitis, Guillain-Barré and Miller Fisher syndromes, acute necrotizing hemorrhagic encephalopathy and hemophagocytic lymphohistiocytosis. These medical signs can be considered direct effects of the virus on the nervous system, para-infectious or post-infectious immune-mediated diseases, and neurological complications of the systemic effects of the SARS-CoV-2.

Case: In the present article, the encephalitis case in a 5-year-old girl positive for COVID-19 admitted to the emergency department complaining of fever and swelling in the neck is described. At this time, her neurological examination was unremarkable. Over the next few days, the fever went down and she experienced acute behavioral changes, mild confusion, and drowsiness. The brain MRI and electroencephalography (EEG) showed CNS involvement, suggestive of encephalitis.

Conclusion: The dramatic improvement of the symptoms after immunotherapy with corticosteroids reinforced the hypothesis of an immune-related mechanism.

Keywords: COVID-19; Encephalitis; Neurological manifestations; Pediatric patient; SARS-CoV-2.

Fig. 1

Ultrasound of the neck indicating the lymph node swelling

Fig. 2

EEG showing a widespread slowing of the underlying rhythm

Fig. 3

Magnetic resonance imaging (MRI) of brain. Axial DWI images show an hyperintense focal lesion in the splenium of corpus callosum and an additional area in the left parietal subcortical site (A and B). Axial T2 image of the same lesion of splenium of corpus callosum that appears subtly hyperintense (C). Axial MRI CE does not evidence any pathological enhancement of the lesion (D)