Two Pediatric Cases of Multisystem Inflammatory Syndrome with Overlapping Neurological Involvement Following SARS-CoV-2 Vaccination and Unknown SARS-CoV2 Infection: The Importance of Pre-Vaccination History

Abstract

The SARS-CoV-2 vaccine roll-out has been successful around the world. However, there are increasing concerns about adverse events. We report two pediatric cases of Multisystem-Inflammatory-Syndrome (MIS-C) with neurological involvement that occurred after SARS-CoV-2 vaccination and unknown recent SARS-CoV-2 infection. Brain magnetic resonance revealed mild-encephalopathy with reversible-splenial-lesion in both cases and complete resolution within 4 weeks. In conclusion, this report aims to describe rare emerging clinical entities that can help pediatricians to make an early diagnosis and to provide appropriate treatment. Multisystem-Inflammatory-Syndromes following COVID-19 vaccination remain rare events. When a history of a recent contact with SARS-CoV-2 is present, a careful evaluation by the clinicians in charge of immunization activities is suggested prior to proceeding with the vaccination.

Electroencephalographic findings post‐COVID‐19 vaccination: A systematic review of case reports and case series

“…Another 11 records were identified from citation ( n = 1) or Google Scholar searches ( n = 10) and were also included. Finally, 31 articles met the eligibility criteria 15,24–53 and were included in the present systematic review (Figure 1).…”

“…The 31 included studies consisted of 24 case reports 15,24–26,28,29,31–34,36,37,39–41,43–50,53 and seven case series 27,30,35,38,42,51,52 (Table 1). In addition, 19 studies were published in 2022 15,36–53 and 12 were published in 2021 24–35 .…”

“…The 31 included studies consisted of 24 case reports 15,24–26,28,29,31–34,36,37,39–41,43–50,53 and seven case series 27,30,35,38,42,51,52 (Table 1). In addition, 19 studies were published in 2022 15,36–53 and 12 were published in 2021 24–35 . Eight studies were conducted in the United States, 30,31,33,36,38,45,48,50 four in Italy, 26,34,49,51 three in Taiwan, 41,44,54 two in Qatar, 24,37 and 18 in other countries.…”

Understanding COVID-19 in children: immune determinants and post-infection conditions

“… 111 This peculiar characteristic could partially explain the high frequency of inflammatory conditions weeks after the SARS-CoV-2 infection, such as MIS-C and MIS-A. In recent months, anti-SARS-CoV-2 post-vaccine reactions, including MIS-C-like forms, 112 – 114 myocarditis, 115 – 117 or autoimmune disorders have been described. 118 However, the incidence of adverse events following immunization is rare and not comparable with post-infection complications even in children.…”

“…Recently, a multisystem inflammatory syndrome temporally associated with SARS-CoV-2 vaccination (MIS-V) has been described. 112 – 114 As for MIS-C, MIS-V is also an almost exclusively pediatric form, as cases reported in the literature among adults are anecdotal. 144 Early reports have proposed that individuals with MIS-V manifest immune system hyperresponsiveness due to recent asymptomatic or symptomatic SARS-CoV-2 infection often suggested by a familial cluster or ascertained by nasopharyngeal swab.…”