Diagnosis and treatment of acute post-infection demyelinating disease. Case-study

Abstract

For almost 2 years, the SARS­CoV­2 pandemic has had a profound impact on the world of medicine and research. Research excitement caused by the new SARS­CoV­2 coronavirus may stimulate the study of demyelinating diseases (multiple sclerosis, acute disseminated encephalomyelitis acute), conversely, deepening our knowledge of the pathogenesis of demyelination and its association with viral infections may lead to studies in the immunopathogenesis of COVID­19. Technological advances that have been rapidly mastered to combat SARS­CoV­2 may soon be used to address multiple sclerosis. A striking example is the potential use of mRNA­based technology to develop tolerant vaccines that suppress CNS autoimmunity. Clinical trials are already underway to evaluate IFN­B, fingolimod, dimethyl fumarate, and masitinib (a tyrosine kinase inhibitor that is effective in phase 3 studies for primary progressive multiple sclerosis) as potent inhibitors of coronavirus.
 The study presents a clinical case of acute disseminated encephalomyelitis (ADEM) associated with SARS­CoV­2 in a 39­year­old woman who was examined and treated at the Lviv Regional Clinical Hospital. The woman complained of severe dizziness, periodic numbness of the tongue, and snowlines of speech. From the anamnesis, it is known that from 07.05.2020 to 20.05.2020 she was treated for confirmed COVID19 infection in the Lviv Regional Infectious Diseases Hospital. Her condition was of moderate severity, she received an oxygen therapy. Neurological manifestations are horizontal nystagmus in both directions, high tendon and periosteal reflexes on all limbs, bilateral Babinski’s symptom, intentional tremor when performing a finger test on both sides. The diagnosis of demyelinating disease (possibly caused by COVID19) was established on the basis of serological studies (polymerase chain reaction to SARSCoV2), clinical findings, magnetic resonance imaging (multiple supra and infratentorial focal lesions of the white matter of the brain). The positive use of corticosteroids in the treatment of acute diffuse encephalomyelitis associated with SARSCoV2 has been reported. Thus, accurate diagnosis and timely treatment of acute demyelinating disease caused by SARSCoV2 virus are of great clinical importance.