Child with tuberculous meningitis and COVID-19 coinfection complicated by extensive cerebral sinus venous thrombosis

Essajee, Farida; Solomons, Regan; Goussard, Pierre; Toorn, Ronald van

doi:10.1136/bcr-2020-238597

Cited by 47 publications

(69 citation statements)

References 11 publications

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“…Our case goes beyond, rather suggesting a runaway of inflammation and hypercoagulation, leading to diffuse and progressive vasculitis, multiple strokes, but also cerebral venous thrombosis. Interestingly, another case may suggest the same mechanism, reporting a 2 year 7-month-old girl with tuberculosis meningitis and Covid-19, complicated by arterial ischemic stroke and cerebral venous thrombosis (26). Tuberculosis meningitis is known to predispose to arterial vasculitis and stroke, but this particularly severe evolution seems similar to our case.…”

Section: Discussionsupporting

confidence: 78%

Case Report: Cerebrovascular Events Associated With Bacterial and SARS-CoV-2 Infections in an Adolescent

et al. 2021

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Neurologic manifestations associated with Covid-19 are increasingly reported, especially stroke and acute cerebrovascular events. Beyond cardiovascular risk factors associated with age, some young adults without medical or cardiovascular history had stroke as a presenting feature of Covid-19. Suggested stroke mechanisms in this setting are inflammatory storm, subsequent hypercoagulability, and vasculitis. To date, a handful of pediatric stroke cases associated with Covid-19 have been reported, either with a cardioembolic mechanism or a focal cerebral arteriopathy. We report the case of an adolescent who presented with febrile meningism and stupor. Clinical, biological, and radiological features favored the diagnosis of Lemierre syndrome (LS), with Fusobacterium necrophorum infection (sphenoid sinusitis and meningitis) and intracranial vasculitis. The patient had concurrent SARS-CoV-2 infection. Despite medical and surgical antimicrobial treatment, stroke prevention, and venous thrombosis prevention, he presented with severe cerebrovascular complications. Venous thrombosis and stroke were observed, with an extension of intracranial vasculitis, and lead to death. As both F. necrophorum and SARS-CoV-2 enhance inflammation, coagulation, and activate endothelial cells, we discuss how this coinfection may have potentiated and aggravated the usual course of LS. The potentiation by SARS-CoV-2 of vascular and thrombotic effects of a bacterial infection may represent an underreported cerebrovascular injury mechanism in Covid-19 patients. These findings emphasize the variety of mechanisms underlying stroke in this disease. Moreover, in the setting of SARS-CoV-2 pandemic, we discuss in what extent sanitary measures, namely, lockdown and fear to attend medical facilities, may have delayed diagnosis and influenced outcomes. This case also emphasizes the role of clinical assessment and the limits of telemedicine for acute neurological condition diagnosis.

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Section: Discussionsupporting

confidence: 78%

Case Report: Cerebrovascular Events Associated With Bacterial and SARS-CoV-2 Infections in an Adolescent

et al. 2021

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“…Brain MRI: normal Recovered without reported deficits Essajee et al. 28 BMJ Case Reports 2020 2.5 years Healthy Lethargic (GCS 11), right pupillary dilatation with right ptosis, left-sided weakness (arm > leg), globally brisk deep tendon reflexes and bilateral extensor plantar responses Cerebral sinus venous thrombosis in the setting of COVID-19 coagulopathy and tuberculosis meningitis SARS CoV-2, Mycobacterium tuberculosis CSF: acellular. Head CT: hydrocephalus, basal meningeal enhancement, and infarction involving the anterior limb of the right internal capsule, lentiform nucleus, and thalamus.…”

Section: Resultsmentioning

confidence: 99%

“…Similar to the case presented by Freji et al., Essajee and colleagues in Cape Town, South Africa, reported concurrence of active M. tuberculosis infection and SARS-CoV-2 in a previously healthy 2.5-year-old girl. 28 Upon presentation, the patient had acute onset of lethargy (Glasgow Coma Scale: 11), right pupillary dilatation with right ptosis, left sided weakness (arm > leg), globally brisk deep tendon reflexes, and bilateral extensor plantar responses. In addition, she had progressively enlarging cervical lymphadenopathy and decreased appetite.…”

Section: Resultsmentioning

confidence: 99%

Coronavirus Infections in the Nervous System of Children: A Scoping Review Making the Case for Long-Term Neurodevelopmental Surveillance

Singer

Evankovich

Fisher

et al. 2021

Pediatric Neurology

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Background The objective of this study was to describe the case literature of human coronavirus infections in the nervous system of children, including from SARS-CoV-2, and to provide guidance to pediatric providers for managing the potential long-term effects on neurodevelopment of human coronavirus infections in the nervous system. Methods Using a structured strategy, the PubMed and Ovid:Embase databases were queried for articles about the clinical presentation and pathophysiology of coronavirus infections in the nervous system of children and young adults, aged 0 to 24 years. Results Of 2302 articles reviewed, 31 described SARS-CoV-2 infections in the nervous system of children and 21 described other human coronaviruses: HCoV-229E, HCoV-NL63, HCoV-OC43, HCoV-HKU1, MERS-CoV, SARS-CoV-1. Excepting MERS-CoV, we found cases of neurological disease in children from each human coronavirus. Children with non-SARS-CoV-2 infections have suffered acute flaccid paralysis, acute disseminated encephalomyelitis, encephalitis, and seizures. In addition, cases of ischemic, hemorrhagic, and microvascular strokes have occurred in children with SARS-CoV-2. Patients with multisystem inflammatory syndrome in children have suffered encephalitis, stroke, pseudotumor cerebri syndrome, and cytotoxic lesions of deep brain structures. Despite these reports, few articles evaluated the impact of human coronavirus infections on long-term neurodevelopmental domains including cognitive, language, academic, motor, and psychosocial outcomes. Conclusions Neurological manifestations of human coronavirus infections can cause severe disease in children. The case literature suggests a critical gap in knowledge of the long-term effects on child neurodevelopment of these infections. As the current SARS-CoV-2 pandemic continues, this gap must be filled to facilitate optimal outcomes in recovering children.

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“…As previously discussed, the association of CVT with COVID-19 has attracted interest from neurologists. Table 1 summarizes the clinical characteristics of the CVT cases associated with CVT that have been reported [ [21] , [22] , [23] , [24] , [25] , [26] , [27] , 32 , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] ]. Hughes et al.…”

Section: Resultsmentioning

confidence: 99%

“…Amongst various neurological manifestations of coronavirus infectious disease of 2019 (COVID-19), CVT has gained recent importance. Multiple reports of SARS-CoV-2 associated with CVT have come to surface and continue to do so [ [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] ]. Whether COVID-19 is truly a causative factor or just a mere association remains elusive [ 32 ].…”

Section: Background and Aimsmentioning

confidence: 99%

Cerebral venous thrombosis in COVID-19

Ghosh

Roy

Mandal

et al. 2021

Diabetes & Metabolic Syndrome: Clinical Research & Revi

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Background and aims Initially, novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) was considered primarily a respiratory pathogen. However, with time it has behaved as a virus with the potential to cause multi-system involvement, including neurological manifestations. Cerebral venous sinus thrombosis (CVT) has increasingly been reported in association with coronavirus infectious disease of 2019 (COVID-19). Here, we have shed light upon CVT and its possible mechanisms in the backdrop of the ongoing COVID-19 pandemic. Methods In this review, data were collected from PubMed, EMBASE and Web of Science, until March 30, 2021, using pre-specified searching strategies. The search strategy consisted of a variation of keywords of relevant medical subject headings and keywords, including “COVID-19”, “SARS-CoV-2”, “coronavirus”, and “cerebral venous sinus thrombosis”. Results COVID-19 has a causal association with a plethora of neurological, neuropsychiatric and psychological effects. CVT has gained particular importance in this regard. The known hypercoagulable state in SARS-CoV-2 infection is thought to be the main mechanism in COVID-19 related CVT. Other plausible mechanisms may include vascular endothelial dysfunction and altered flow dynamics. Conclusions Although there are no specific clinical characteristics, insidious or acute onset headache, seizures, stroke-like, or encephalopathy symptoms in a patient with, or who has suffered COVID-19, should prompt the attending physician to investigate for CVT. The treatment of COVID-19 associated CVT does not differ radically from the therapy of CVT without the infection, i.e. urgent initiation of parenteral unfractionated heparin or low molecular weight heparin followed by conventional or mostly newer oral anticoagulants.

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Child with tuberculous meningitis and COVID-19 coinfection complicated by extensive cerebral sinus venous thrombosis

Cited by 47 publications

References 11 publications

Case Report: Cerebrovascular Events Associated With Bacterial and SARS-CoV-2 Infections in an Adolescent

Case Report: Cerebrovascular Events Associated With Bacterial and SARS-CoV-2 Infections in an Adolescent

Coronavirus Infections in the Nervous System of Children: A Scoping Review Making the Case for Long-Term Neurodevelopmental Surveillance

Cerebral venous thrombosis in COVID-19

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