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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| Format: | Article |
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Wiley
2021-01-01
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| Series: | Case Reports in Neurological Medicine |
| Online Access: | http://dx.doi.org/10.1155/2021/6658000 |
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| author | Katerina Vraka Dipak Ram Siobhan West Wei Yen Evelyn Chia Praveen Kurup Gayathri Subramanian Hui Jeen Tan |
| author_facet | Katerina Vraka Dipak Ram Siobhan West Wei Yen Evelyn Chia Praveen Kurup Gayathri Subramanian Hui Jeen Tan |
| author_sort | Katerina Vraka |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-e301b52f393f4c0cbc892fa96a5f9088 |
| institution | Kabale University |
| issn | 2090-6668 2090-6676 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Neurological Medicine |
| spelling | doaj-art-e301b52f393f4c0cbc892fa96a5f90882025-02-03T01:28:28ZengWileyCase Reports in Neurological Medicine2090-66682090-66762021-01-01202110.1155/2021/66580006658000Two Paediatric Patients with Encephalopathy and Concurrent COVID-19 Infection: Two Sides of the Same Coin?Katerina Vraka0Dipak Ram1Siobhan West2Wei Yen Evelyn Chia3Praveen Kurup4Gayathri Subramanian5Hui Jeen Tan6Department of Paediatric Neurology, Rotal Manchester Children’s Hospital, Manchester M13 9WL, UKDepartment of Paediatric Neurology, Rotal Manchester Children’s Hospital, Manchester M13 9WL, UKDepartment of Paediatric Neurology, Rotal Manchester Children’s Hospital, Manchester M13 9WL, UKDepartment of Paediatric Intensive Care Unit, Rotal Manchester Children’s Hospital, Manchester M13 9WL, UKDepartment of Paediatric Intensive Care Unit, Rotal Manchester Children’s Hospital, Manchester M13 9WL, UKDepartment of Paediatric Intensive Care Unit, Rotal Manchester Children’s Hospital, Manchester M13 9WL, UKDepartment of Paediatric Neurology, Rotal Manchester Children’s Hospital, Manchester M13 9WL, UKThere 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.http://dx.doi.org/10.1155/2021/6658000 |
| spellingShingle | Katerina Vraka Dipak Ram Siobhan West Wei Yen Evelyn Chia Praveen Kurup Gayathri Subramanian Hui Jeen Tan Two Paediatric Patients with Encephalopathy and Concurrent COVID-19 Infection: Two Sides of the Same Coin? Case Reports in Neurological Medicine |
| title | Two Paediatric Patients with Encephalopathy and Concurrent COVID-19 Infection: Two Sides of the Same Coin? |
| title_full | Two Paediatric Patients with Encephalopathy and Concurrent COVID-19 Infection: Two Sides of the Same Coin? |
| title_fullStr | Two Paediatric Patients with Encephalopathy and Concurrent COVID-19 Infection: Two Sides of the Same Coin? |
| title_full_unstemmed | Two Paediatric Patients with Encephalopathy and Concurrent COVID-19 Infection: Two Sides of the Same Coin? |
| title_short | Two Paediatric Patients with Encephalopathy and Concurrent COVID-19 Infection: Two Sides of the Same Coin? |
| title_sort | two paediatric patients with encephalopathy and concurrent covid 19 infection two sides of the same coin |
| url | http://dx.doi.org/10.1155/2021/6658000 |
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