Acute Corticosteroid Responsive Meningoencephalitis with Cerebral Vasculitis after COVID-19 Infection in a Thirteen-Year-Old

Abstract

Introduction: Various neurologic manifestations have already been described in children during or after severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) infections,. The central nervous system disorders reported in children are mainly encephalopathies during Multisystem inflammatory syndrome (MIS-C). We present here an acute meningo-encephalitis with cerebral vasculitis associated to a COVID-19 infection in a thirteen-year-old girl with a 1-year clinical, EEG and MRI follow-up. Case-report: A thirteen-year-old girl presented acute symptoms of consciousness impairment, frontal headache, hyperthermia and aphasia, with moderate lymphopenia (900/mm3),elevated C-reactive protein (CRP) (17mg/l), cerebrospinal fluid (CSF) pleiocytosis (15 cells/mm3), slow background with frontal focalization on electroencephalogram (EEG), an left frontal ischemic lesion, leptomeningeal enhancement and bilateral limbic FLAIR hyperintensity on cerebral magnetic resonance imaging (MRI). Reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV2 was positive in nasopharyngeal swab and COVID serology was positive for IgM and Ig, whereas extensive auto-immune antibody investigation was negative except for a positive low titre of anti-MOG 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 laters, 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 an 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

Clinical manifestations and EEG findings in children infected with COVID-19 and exhibiting neurological symptoms

“…It was found that the EEGs of these patients in this study were non-specific, with slow background activity. This result was consistent with previously reported EEG findings in two cases of encephalitis in COVID-19 pediatric patients [ 28 , 29 ]. Moreover, we noted abnormal discharge in the frontal region of the patient suffering from acute encephalopathy syndrome.…”