Two Paediatric Patients with Encephalopathy and Concurrent COVID-19 Infection: Two Sides of the Same Coin?

There is increasing evidence that SARS-CoV-2 has neurotropic potential. We report on two paediatric patients who presented with encephalopathy during COVID-19 illness. Both patients had ADEM-like changes in their neuroimaging, negative SARS-CoV-2 RNA PCR in CSF, and paucity of PIMS-TS laboratory fin...

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Veröffentlicht in:Case reports in neurological medicine Jg. 2021; S. 1 - 4
Hauptverfasser: Vraka, Katerina, Ram, Dipak, West, Siobhan, Chia, Wei Yen Evelyn, Kurup, Praveen, Subramanian, Gayathri, Tan, Hui Jeen
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States Hindawi 24.03.2021
John Wiley & Sons, Inc
Wiley
Schlagworte:
Adenoviruses
Antibiotics
Antibodies
Case Report
Case reports
Coronaviruses
COVID-19
Critical care
Encephalitis
Encephalopathy
Glycoproteins
Hypertension
Illnesses
Immunization
Infections
Laboratories
Levetiracetam
Medical research
Medicine, Experimental
Pediatrics
Proteins
Serology
Severe acute respiratory syndrome coronavirus 2
Viral antibodies
Virology
United Kingdom
ISSN:2090-6668, 2090-6676
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Zusammenfassung:There is increasing evidence that SARS-CoV-2 has neurotropic potential. We report on two paediatric patients who presented with encephalopathy during COVID-19 illness. Both patients had ADEM-like changes in their neuroimaging, negative SARS-CoV-2 RNA PCR in CSF, and paucity of PIMS-TS laboratory findings. However, the first patient was positive for serum MOG antibodies with normal CSF analysis, and the second had negative MOG antibodies but showed significant CSF lymphocytic pleocytosis. We concluded that the first case was a typical case of demyelination, which could have been triggered by different cofactors. In the second case, however, we postulated that the encephalopathic process was triggered by SARS-CoV-2, as no other cause was identified. With these two contrasting cases, we provide evidence that SARS-CoV-2-associated encephalitis can show ADEM-like changes, which can present during the postinfectious phase of COVID-19 illness. As ADEM is a relatively common type of postinfectious encephalitis in children, the distinguishing line between the two conditions of encephalitis and ADEM can be relatively fine. The development of more reliable diagnostic tools (e.g., anti-SARS-CoV-2 antibodies in CSF) might play an assisting role in the differentiation of these encephalopathic processes.
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Academic Editor: Mathias Toft
ISSN:2090-6668
2090-6676
DOI:10.1155/2021/6658000