Supratentorial Demyelinating Lesions Following Severe Acute Respiratory Syndrome Coronavirus-2 Infection: A Pediatric Case Report
Introduction Most coronavirus disease 2019 (COVID-19) pediatric patients are asymptomatic; however, several neurological manifestations associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection have been reported. Demyelinating events such as acute disseminated encephalomyelitis have been recently included among potential complications of COVID-19.
Case Report We describe the case of a 12-year-old boy who developed central nervous system demyelinating lesions following SARS-CoV-2 infection. Two months prior he had been diagnosed with panuveitis but was otherwise healthy. Three weeks after testing positive for SARS-CoV-2, he started to complain of right temporal headache associated with right orbital pain without vision impairment. Brain magnetic resonance imaging showed large leukodystrophy-like demyelinating lesions. Standard electroencephalogram revealed a slow activity on the right hemisphere. His clinical and electroencephalographic course was favorable, with a good response to corticosteroid therapy and infusions of intravenous immunoglobulins. Delayed but complete resolution of brain lesions was noted on imaging.
Conclusion Our case contributes to broaden the knowledge regarding the spectrum of possible complications of SARS-CoV-2 infection. The relative lack of clinical manifestations in our patient can be seen as a warning not to underestimate even mild neurological symptoms correlated with COVID-19.
Eingereicht: 08. Mai 2022
Angenommen: 26. August 2022
Artikel online veröffentlicht:
23. Dezember 2022
© 2022. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Guan WJ, Ni ZY, Hu Y. et al; China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382 (18) 1708-1720
- 2 Lindan CE, Mankad K, Ram D. et al; ASPNR PECOBIG Collaborator Group. Neuroimaging manifestations in children with SARS-CoV-2 infection: a multinational, multicentre collaborative study. Lancet Child Adolesc Health 2021; 5 (03) 167-177
- 3 Pavone P, Ceccarelli M, Marino S. et al. SARS-CoV-2 related paediatric acute-onset neuropsychiatric syndrome. Lancet Child Adolesc Health 2021; 5 (06) e19-e21
- 4 Krupp LB, Tardieu M, Amato MP. et al; International Pediatric Multiple Sclerosis Study Group. International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions. Mult Scler 2013; 19 (10) 1261-1267
- 5 Tenembaum S, Chitnis T, Ness J, Hahn JS. International Pediatric MS Study Group. Acute disseminated encephalomyelitis. Neurology 2007; 68 (16, Suppl 2): S23-S36
- 6 Uluduz D, Kürtüncü M, Yapıcı Z. et al. Clinical characteristics of pediatric-onset neuro-Behçet disease. Neurology 2011; 77 (21) 1900-1905
- 7 Zelada-Ríos L, Pacheco-Barrios K, Galecio-Castillo M, Yamunaqué-Chunga C, Álvarez-Toledo K, Otiniano-Sifuentes R. Acute disseminated encephalomyelitis and COVID-19: a systematic synthesis of worldwide cases. J Neuroimmunol 2021; 359: 577674
- 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 Akçay N, Bektaş G, Menentoğlu ME. et al. COVID-19-associated acute disseminated encephalomyelitis-like disease in 2 children. Pediatr Infect Dis J 2021; 40 (11) e445-e450
- 10 de Miranda Henriques-Souza AM, de Melo ACMG, de Aguiar Coelho Silva Madeiro B, Freitas LF, Sampaio Rocha-Filho PA, Gonçalves FG. Acute disseminated encephalomyelitis in a COVID-19 pediatric patient. Neuroradiology 2021; 63 (01) 141-145
- 11 Dominguez-Rojas J, Alvarado-Gamarra G, Del AguilaO. et al. Manifestaciones extra pulmonares COVID-19 en pediatrìa: reporte tres casos hospital Edgardo Rebagliati Martins. Intensivos 2020; 13 (03) 168-174
- 12 Manzo ML, Galati C, Gallo C. et al. ADEM post-Sars-CoV-2 infection in a pediatric patient with Fisher-Evans syndrome. Neurol Sci 2021; 42 (10) 4293-4296
- 13 Siracusa L, Cascio A, Giordano S. et al. Neurological complications in pediatric patients with SARS-CoV-2 infection: a systematic review of the literature. Ital J Pediatr 2021; 47 (01) 123
- 14 Hacohen Y, Rossor T, Mankad K. et al. ‘Leukodystrophy-like’ phenotype in children with myelin oligodendrocyte glycoprotein antibody-associated disease. Dev Med Child Neurol 2018; 60 (04) 417-423
- 15 Tan PY, Furness J, Sohal AS, Ramesh V, Haider S. A case of intermediate uveitis as a precursor to acute disseminated encephalomyelitis (ADEM) in a teenager. Eye (Lond) 2014; 28 (05) 625-627