Neuro-PIMS-TS: a single case report and review of the literature

Abstract

Neurological manifestations related to SARS-CoV-2 infection in adults have been largely reported since the beginning of the pandemic. Subsequent large-scale studies involving children confirmed the occurrence of neurological symptoms associated with SARS-CoV-2 infection also among paediatric patients, especially in the context of paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS). At this regard, we report the challenging case of a 10-month-old baby with PIMS-TS complicated by acute cerebral oedema successfully treated with intravenous immunoglobulins, corticosteroids and anakinra. Our results, combined with the evidence of larger case series suggest that higher inflammatory burden is more frequent in patients with neuro PIMS-TS. As regards neuroimaging, neuroimmune disorders are found to be more common during acute COVID-19, MERS is more frequent during PIMS-TS. Distinct immune mechanisms may underlie these different types of neurological involvement, which are yet to be understood. Further studies are required to better define the physiopathology of neuro PIMS-TS and its possible therapeutical implications.

Keywords: Kawasaki disease; MIS-C; PIMS-TS; neurological manifestations.

Figure 1.

Radiological findings in our neuro PIMS-TS patient: (a) brain CT reporting cerebral oedema, with meningeal and cerebral herniation from the anterior fontanelle, (b) brain MRI showing periventricular hyperintensities without restricted diffusion, (c) and (d) left and right coronary artery ectasia, respectively. CT, computed tomography; MRI, magnetic resonance imaging; PIMS-TS, pediatric inflammatory multisystem syndrome tempo rally associated with COVID-19.

Figure 2.

Timeline of patient course. CT, computed tomography; DXM, dexamethasone; IV, intravenous; IVIG, intravenous immunoglobulin; MPDN, methylprednisolone; MRI, magnetic resonance imaging; MU, measurement units; NV, normal values; SC, subcutaneous.