Acute Corticosteroid Responsive Meningoencephalitis with Cerebral Vasculitis after COVID-19 Infection in a Thirteen-Year-OldFunding None.
Introduction Various neurologic manifestations have already been described in children during or after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. The central nervous system disorders reported in children are mainly encephalopathies during multisystem inflammatory syndrome. We present here an acute meningoencephalitis with cerebral vasculitis associated to a coronavirus disease 2019 (COVID-19) infection in a 13-year-old girl with a 1-year clinical, electroencephalogram (EEG), and magnetic resonance imaging (MRI) follow-up.
Case Report A 13-year-old girl presented acute symptoms of consciousness impairment, frontal headache, hyperthermia, and aphasia, with moderate lymphopenia (900/mm3), elevated C-reactive protein (17 mg/L), cerebrospinal fluid (CSF) pleocytosis (15 cells/mm3), slow background with frontal focalization on EEG, a left frontal ischemic lesion, leptomeningeal enhancement, and bilateral limbic fluid-attenuated inversion recovery hyperintensity on cerebral MRI. Reverse transcription-polymerase chain reaction for SARS-CoV-2 was positive in nasopharyngeal swab and COVID serology was positive for immunoglobulin (Ig) M and G, whereas extensive autoimmune antibody investigation was negative except for a positive low titer of anti-myelin oligodendrocyte glycoprotein in CSF and blood. The diagnosis of probable encephalitis associated to cerebral vasculitis after COVID infection was suggested and steroids pulse were started. She recovered within a few days. Six months later, she had moderate clinical sequels including persistent intermittent headaches, an isolated spatial deficit, and focal spikes on the EEG without argument for epilepsia.
Conclusion A teenager without previous medical history presented with acute encephalitis with leptomeningitis and vasculitis after a recent COVID-19 infection. Steroids pulse therapy allowed clinical improvement. Cerebral MRI and EEG helped diagnosis, follow-up of the encephalitis, and evolution after treatment.
Eingereicht: 16. November 2021
Angenommen: 06. Juli 2022
Accepted Manuscript online:
11. Juli 2022
Artikel online veröffentlicht:
23. Dezember 2022
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- 1 Ellul MA, Benjamin L, Singh B. et al. Neurological associations of COVID-19. Lancet Neurol 2020; 19 (09) 767-783
- 2 LaRovere KL, Riggs BJ, Poussaint TY. et al; Overcoming COVID-19 Investigators. Neurologic involvement in children and adolescents hospitalized in the United States for COVID-19 or multisystem inflammatory syndrome. JAMA Neurol 2021; 78 (05) 536-547
- 3 Ray STJ, Abdel-Mannan O, Sa M. et al; CoroNerve study group. Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study. Lancet Child Adolesc Health 2021; 5 (09) 631-641
- 4 Chiotos K, Bassiri H, Behrens EM. et al. Multisystem inflammatory syndrome in children during the coronavirus 2019 pandemic: a case series. J Pediatric Infect Dis Soc 2020; 9 (03) 393-398
- 5 Poisson KE, Zygmunt A, Leino D. et al. Lethal pediatric cerebral vasculitis triggered by severe acute respiratory syndrome coronavirus 2. Pediatr Neurol 2022; 127: 1-5
- 6 Algarni AS, Alamri NM, Khayat NZ, Alabdali RA, Alsubhi RS, Alghamdi SH. Clinical practice guidelines in multisystem inflammatory syndrome (MIS-C) related to COVID-19: a critical review and recommendations. World J Pediatr 2022; 18 (02) 83-90
- 7 Abel D, Shen MY, Abid Z. et al. Encephalopathy and bilateral thalamic lesions in a child with MIS-C associated with COVID-19. Neurology 2020; 95 (16) 745-748
- 8 Abdel-Mannan O, Eyre M, Löbel U. et al. Neurologic and radiographic findings associated with COVID-19 infection in children. JAMA Neurol 2020; 77 (11) 1440-1445
- 9 Hilado M, Banh M, Homans J, Partikian A. Pediatric autoimmune encephalitis following COVID-19 infection. J Child Neurol 2022; 37 (04) 268-272
- 10 Venkatesan A, Tunkel AR, Bloch KC. et al; International Encephalitis Consortium. Case definitions, diagnostic algorithms, and priorities in encephalitis: consensus statement of the International Encephalitis Consortium. Clin Infect Dis 2013; 57 (08) 1114-1128
- 11 Varga Z, Flammer AJ, Steiger P. et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet 2020; 395 (10234): 1417-1418
- 12 Gilden DH, Kleinschmidt-DeMasters BK, LaGuardia JJ, Mahalingam R, Cohrs RJ. Neurologic complications of the reactivation of varicella-zoster virus. N Engl J Med 2000; 342 (09) 635-645
- 13 Pinto AA, Carroll LS, Nar V, Varatharaj A, Galea I. CNS inflammatory vasculopathy with antimyelin oligodendrocyte glycoprotein antibodies in COVID-19. Neurol Neuroimmunol Neuroinflamm 2020; 7 (05) e813
- 14 Sechi E, Buciuc M, Pittock SJ. et al. Positive predictive value of myelin oligodendrocyte glycoprotein autoantibody testing. JAMA Neurol 2021; 78 (06) 741-746
- 15 Salvarani C, Brown Jr RD, Calamia KT. et al. Primary central nervous system vasculitis: analysis of 101 patients. Ann Neurol 2007; 62 (05) 442-451