Transverse Myelitis in a Child With COVID-19

Kaur, Harsheen; Mason, John Alan; Bajracharya, Manish; McGee, John P.; Gunderson, Matthew; Hart, Blaine L.; Dehority, Walter; Link, Nathaniel; Moore, Brian C. J.; Phillips, J. P.; Rogers, Danny H.

doi:10.1016/j.pediatrneurol.2020.07.017

Cited by 70 publications

(105 citation statements)

References 4 publications

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“…Complete recovery was seen in 1/18(5.6%) ( Chow et al, 2020 ), moderate improvement in 5/18 (27.7%) ( Zhou et al, 2019 ; Novi et al, 2020 ; Munz et al, 2020 ; Sarma et al, 2020 ; AlKetbi et al, 2020 ), mild improvement in 9/18(50.0%) ( Zoghi et al, 2020 ; Maideniuc et al, 2020 ; Valiuddin et al, 2020 ; Masuccio et al, 2020 ; Zachariadis et al, 2020 ; Águila-Gordo et al, 2020 ; Sotoca et al, 2020 ; Baghbanian et al, 2020 ), no improvement in 1/18(5.6%) ( Kaur et al, 2020 ) and 2 deaths (11.1%) ( Chakraborty et al, 2020 ; Abdelhady et al, 2020 ).…”

Section: Resultsmentioning

confidence: 99%

“…Corticosteroids were the most common treatment (14/18): the most frequent regimen was methylprednisolone 1g/day for 3 (1/15) or 5 days (8/15). However, prednisone adjusted by weight dose in a pediatric case ( Kaur et al, 2020 ), or in a low dose (100mg/d) ( Munz et al, 2020 ) are also registered. Dexamethasone 10 mg/10 days was used in 2 cases ( Águila-Gordo et al, 2020 ; Zhao et al,2020 ).…”

Section: Resultsmentioning

confidence: 99%

“…Other treatments registered were intravenous immunoglobulin (IVIg) in 6/18 patients at 0.4 g/kg/day for 5 days to 7 days ( Baghbanian et al, 2020 ), and plasma exchange (PLEX) in 8/18 cases, frequently combined with corticosteroids (6/8). Duration of PLEX therapy varied from 2 days (1/7) ( Sarma et al, 2020 ) to 7 sessions (1/7) ( Kaur et al, 2020 ) being the most common number of sessions 5 (5/8).…”

Section: Resultsmentioning

confidence: 99%

“…We have presented a case with some unique characteristics: mielytis is developed in an asymptomatic Covid-19 patient, the patient presented a small lesion, and an anti-GD2/GD3 IgM was found. Previously, only a 3-year-old girl patient being asymptomatic for Covid-19 with a LETM was described ( Kaur et al, 2020 ). Other cases had more or less severe Covid-19 symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Our review allows us to recognize that Covid19 para-infectious myelitis can appear from asymptomatic to severe Covid-19 patients. The degree of spinal involvement was highly variable ranging from ad-integrum improvements ( Chow et al, 2020 ) and little radiological involvement ( Novi et al, 2020 ; Zachariadis et al, 2020 ) to severe clinical forms and almost complete involvement of the spinal cord ( Sotoca et al, 2020 ; Kaur et al, 2020 ; Sarma et al, 2020 ; AlKetbi et al, 2020 ). However, the most common phenotype was LETM.…”

Section: Discussionmentioning

confidence: 99%

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Para-infectious anti-GD2/GD3 IgM myelitis during the Covid-19 pandemic: Case report and literature review

Antonio

Suárez

Fernández-Barriuso

et al. 2021

Multiple Sclerosis and Related Disorders

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Background: Even though SARS-CoV-2 is a predominantly respiratory virus, several reports have described various neurological disorders, from the beginning of the pandemic. The first para-infectious myelitis case was described in Wuhan in February 2020. Nevertheless, data from registries and reviews are scarce. Methods: A 40-year-old female with T5-T6 SARS-CoV-2 para-infectious myelitis is reported. A literature review of the published literature on the SARS-CoV-2 and para-infectious myelitis was done. Epidemiological, clinical, laboratory, image, treatment, and outcome data are described. Results: Particular findings of our case are that Covid-19 was asymptomatic and anti-GD2/GD3 IgM was found. 18 para-infectious myelitis occurred over a wide age range (Beh et al., 2013-67), mean age 50.7±18.6 years, with 10/18 (55.6%) women. Covid-19 involvement was variable from asymptomatic cases to severe Covid-19 resulting in death. The mean time to establish myelitis from the onset of Covid-19 symptoms was 10.3 ±7.8 days (0-24). The most common clinical form was transverse myelitis (14/18 patients, 77.7%) and the most frequent radiological form was longitudinally extensive myelitis (11/17 patients, 64.7%). In CSF mild lymphocytosis (14/16, 87.5%) with low cellularity (40.9±49.7/μL) and elevated proteins (11/16, 77.8%, mean 145.0 mg±159.0/dL) were frequent. Oligoclonal bands were usually negative (7/9, 77.7%) and mirror pattern was found in 2/7 patients (33.3%). SARS-CoV-2 PCR in CSF was negative in 10/10 cases. Conclusion: SARS-CoV-2 can cause myelitis by immune-mediated mechanisms. Clinical-radiological characteristics of Covid-19 para-infectious myelitis were variable and non-specific.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Para-infectious anti-GD2/GD3 IgM myelitis during the Covid-19 pandemic: Case report and literature review

Antonio

Suárez

Fernández-Barriuso

et al. 2021

Multiple Sclerosis and Related Disorders

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Neurological Complications of COVID-19

Walton

Acampora²,

Wood

et al. 2022

Frontiers of COVID-19

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Neuroimmunologie von COVID‑19

et al. 2021

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ZusammenfassungZahlreiche neuroimmunologische Krankheitsbilder wie Enzephalopathien, Enzephalitiden, Myelitiden oder ADEM (akute disseminierte Enzephalomyelitis) sind nach einer Infektion mit SARS-CoV‑2 („severe acute respiratory syndrome coronavirus 2“) gehäuft aufgetreten, was für einen para- oder postinfektiösen Zusammenhang spricht. Ursächlich ist wahrscheinlich eine virusgetriggerte Überaktivierung des Immunsystems mit Hyperinflammation und Zytokin-Sturm, aber möglicherweise auch die Bildung spezifischer Autoantikörper gegen Gewebe des Zentralnervensystems, die sich vor allem im Liquor schwerkranker COVID-19(„coronavirus disease 2019“)-Patienten finden lassen. Eine direkte Schädigung durch die Invasion von SARS-CoV‑2 ins Gehirn oder Rückenmark scheint keine relevante Rolle zu spielen. Bei Patienten mit Multipler Sklerose, Myasthenie oder anderen neuroimmunologischen Krankheitsbildern wird die Anfälligkeit für eine SARS-CoV-2-Infektion sowie das Risiko eines schweren Verlaufs nicht durch die immunmodulierende Therapie bestimmt, sondern durch bekannte Risikofaktoren wie Alter, Komorbiditäten und den krankheitsbedingten Grad der Behinderung. Immuntherapien sollten bei diesen Patienten daher nicht verschoben oder pausiert werden. Inwieweit neuroimmunologische Mechanismen auch für Langzeitfolgen nach überstandener COVID-19-Erkrankung – wie Fatigue, Gedächtnis‑, Schlaf- oder Angststörungen – verantwortlich sind, werden klinische Verlaufsuntersuchungen u. a. in COVID-19-Registerstudien zeigen.

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Transverse Myelitis in a Child With COVID-19

Cited by 70 publications

References 4 publications

Para-infectious anti-GD2/GD3 IgM myelitis during the Covid-19 pandemic: Case report and literature review

Para-infectious anti-GD2/GD3 IgM myelitis during the Covid-19 pandemic: Case report and literature review

Neurological Complications of COVID-19

Neuroimmunologie von COVID‑19

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