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Case Reports
. 2023 Feb 22:14:1099458.
doi: 10.3389/fneur.2023.1099458. eCollection 2023.

Case report: A case of acute disseminated encephalomyelitis after SARS-CoV-2 infection in pediatric patients

Affiliations
Case Reports

Case report: A case of acute disseminated encephalomyelitis after SARS-CoV-2 infection in pediatric patients

Francesca Cautilli et al. Front Neurol. .

Abstract

Introduction: Since the beginning, there has been enough evidence about the multi-systematic involvement of the coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Recent observations have revealed that, together with others, typical neurological manifestations are also associated with COVID-19 infection. In the first 2 years, children accounted for a few percent of cases, but with the emergence of the Omicron variant, the number of cases in the pediatric population has increased. It has been described that ~5% of the affected population suffered from severe neurological complications, such as seizure, coma, encephalitis, demyelinating disorders, and aseptic meningitis. Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system. Typically, it presents in childhood and occurs 1 or 2 weeks after infection or vaccination.

Case presentation: We present the case of a 12-year-old boy who developed ADEM, 10 days after an asymptomatic SARS-CoV-2 infection. Neurological symptoms began with headache, fever, irritability, paraplegia, and loss of sensitivity from the T1 level. The diagnosis of ADEM was confirmed by the typical signs found on brain MRI, whereas spinal cord MRI showed signs of transverse myelitis. The cerebrospinal fluid (CSF) testing excluded infections and did not reveal oligoclonal antibody bands (anti-MOG-negative and anti-AQP-negative). High-dose steroids (30 mg/kg/day) and IVIG (2 g/kg) were administered to the patient without any clinical improvement. The patient received a cycle of plasma exchange therapy, followed by rituximab infusion, with partial improvement. After 3 months, the magnetic resonance imaging (MRI) results demonstrated radiological improvement in accordance with the ADEM diagnosis.

Conclusion: This clinical case confirms that SARS-CoV-2 infections are increasingly implicated in severe neurological consequences in both adult and pediatric patients. While the most frequent complications that were reported in children included headache, altered mental status, and encephalopathy, ~5% of the individuals suffered from severe neurological complications, leading to lifelong sequelae. All physicians must be aware of these data and detect neurological signs of severe (or not) complications that require a specific follow-up and treatment.

Keywords: COVID-19; acute disseminated encephalopathy; children; complications; neurological complications.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Three-dimensional (3D) brain MRI, brain sagittal image with signal alteration corresponding to the subcortical white substance.
Figure 2
Figure 2
T1-weighted brain MRI, brain axial image with signal alteration in the subcortical white substance.
Figure 3
Figure 3
T2-weighted (T2W) turbo spin echo (TSE) magnetic resonance imaging (MRI), spinal cord sagittal image with signal alterations from C4 to the conus medullaris.
Figure 4
Figure 4
T2 MRI, spinal cord sagittal image without alterations.
Figure 5
Figure 5
T2 MRI, brain coronal image without alterations.
Figure 6
Figure 6
T2 MRI, brain axial image without alterations.

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