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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Published in:	Case reports in neurological medicine Vol. 2021; pp. 1 - 4
Main Authors:	Vraka, Katerina, Ram, Dipak, West, Siobhan, Chia, Wei Yen Evelyn, Kurup, Praveen, Subramanian, Gayathri, Tan, Hui Jeen
Format:	Journal Article
Language:	English
Published:	United States Hindawi 24.03.2021 John Wiley & Sons, Inc Wiley
Subjects:	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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Abstract	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.
AbstractList	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. 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.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.
Audience	Academic
Author	Kurup, Praveen Ram, Dipak Subramanian, Gayathri Chia, Wei Yen Evelyn Tan, Hui Jeen Vraka, Katerina West, Siobhan
AuthorAffiliation	1 Department of Paediatric Neurology, Rotal Manchester Children's Hospital, Manchester M13 9WL, UK 2 Department of Paediatric Intensive Care Unit, Rotal Manchester Children's Hospital, Manchester M13 9WL, UK
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Cites_doi	10.14573/altex.2006111 10.1007/s00415-020-09929-7 10.1016/j.cell.2020.02.052 10.1212/nxi.0000000000000893 10.1016/s1474-4422(20)30221-0 10.1001/jamaneurol.2020.2687
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References	1 2 Royal College of Paediatrics and Child Health Guidance (4) 2020 A. C. Anilkumar (9) 2020 5 J. Meinhardt (6) 2020; 24 7 8 C. E. Lindan (3) 2020; 5 10
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SubjectTerms	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
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Title	Two Paediatric Patients with Encephalopathy and Concurrent COVID-19 Infection: Two Sides of the Same Coin?
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