Paediatric transverse myelitis during COVID-19 asymptomatic infection: A case report

Abstract

pathogenesis. Clinical heterogeneity and confounding factors also impair the search for alternative mechanisms. Therefore, we studied the CSF of 13 patients with neurological symptoms during the acute phase of their hospitalization, looking for clues suggesting a specific dysimmune phenomenon. MethodsCSF underwent conventional analysis and RT-PCR for SARS-CoV-2; a in-house HEK293 cell-based assay was also arranged to identify anti-spike antibodies. Albumin ratio, IgG index and oligoclonal bands were also assessed, along with a screening for autoimmune antibodies. First, commercial immunofluorescence and lineblot were used to detect common neuronal surface and intracellular antibodies, respectively; secondly, immunohistochemistry was performed on rat brain sections; lastly, CSF was incubated with fixed murine neuron and astrocyte cultures to confirm a potential auto-reactivity. ResultsCSF analysis disclosed a slightly increased protein level with a non-significant cell count (0-10 cells/uL). Neither SARS-CoV-2 nor common neuronal antibodies were detectable in the CSF, but we recognized anti-spike IgGs. 69% of the samples also showed neuropil staining, some of which had a common staining pattern involving the hippocampal dentate gyrus. Rodent primary cultures confirmed the presence of autoreactive antibodies against epitopes that are expressed in cortical neurons and/or astrocytes in most samples. ConclusionsA strong immunoreactivity against spike protein was found in the CSF of those patients, even without a significant blood brain barrier permeability. The detection of auto reactivity with two different techniques could thus represent a dysimmune response to COVID-19 infection, perhaps suggesting molecular mimicry.

Acute Transverse Myelitis in a Paediatric Patient with Coronavirus Disease-19; a Case Report

“…Despite minor improvement, it was deemed necessary for him to undergo gastrostomy and tracheostomy (16). Grasso et al reported the case of a 12-year-old boy with an asymptomatic COVID-19 infection (17). The patient complained of nuchal pain followed by hypoesthesia on the right hemisoma that persisted for twelve hours.…”