Abstract Details

Title A Case of COVID-19 Infection and Subsequent CNS Vasculitis Flare in a Patient with Previously Stable Disease

Topic Multiple Sclerosis

Presentation(s) MS and CNS Inflammatory Disease Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 016

Objective To present a patient with previously stable CNS vasculitis who demonstrated new ischemic strokes in the setting of the 2019 novel coronavirus (COVID-19) infection.

Background COVID-19 was declared a global pandemic in March 2020 and has killed over 1 million people worldwide (WHO). It has become apparent that severe symptoms may be the result of a secondary cytokine storm in response to the infection. Several systemic and neurologic autoimmune diseases have been noted to occur in concert with COVID-19 infection, and this overactive immune response to COVID may trigger flare ups in patients with known neuroimmunological diseases.

Design/Methods Case report

Results A 56 year old woman with known CNS vasculitis had been stable for 16 months and maintained on mycophenolic acid. However, 3 weeks after a mild infection with COVID-19 (diagnosed retrospectively with positive serum SARS-CoV-2 IgG and known family member with a positive PCR during acute infection), she was found on surveillance MRI to have new infarcts and associated vessel wall enhancement, suggesting worsening vasculitis. She was treated with 3 days of intravenous (IV) methylprednisolone and 3 cycles of monthly IV cyclophosphamide with no further events and resolution of her vessel wall enhancement and subsequently transitioned to maintenance therapy with mycophenolic acid.

Conclusions Here we report a case of worsening CNS vasculitis, evidenced by new infarcts and inflammatory changes on MRI with vessel wall imaging, in a previously stable patient with no disease activity for 16 months following a mild COVID-19 infection. Thus, suggesting COVID-19 may trigger relapses in patients with known neuroinflammatory diseases. It is not clear if acute immunotherapy, adjustments in maintenance immunotherapy, and/or supportive care are most appropriate for these flares of infection related disease activity. Additionally, larger studies are needed to understand the risk of worsening disease activity in autoimmune or neuroinflammatory disease in the setting of COVID-19 infection.

Authors/Disclosures
Madeline Garza, MD PRESENTER	Dr. Garza has nothing to disclose.
Ryan Kammeyer, MD (Childrens Hospital Colorado)	The institution of Dr. Kammeyer has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amgen. The institution of Dr. Kammeyer has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Kammeyer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Ogborn-Mihm Trial Lawyers. The institution of Dr. Kammeyer has received research support from Rocky Mountain Multiple Sclerosis Center.
Baber Khan, MD (Riverhills Neuroscience)	Dr. Khan has nothing to disclose.
Constance McMenamin, NP (University of Colorado/ MS Clinic)	Ms. McMenamin has nothing to disclose.
Amanda L. Piquet, MD, FAAN (University of Colorado)	The institution of Dr. Piquet has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech/Roche. The institution of Dr. Piquet has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion. The institution of Dr. Piquet has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Kyverna . The institution of Dr. Piquet has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech/Roche. The institution of Dr. Piquet has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Kyverna. The institution of Dr. Piquet has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Piquet has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Sands Anderson PC. Dr. Piquet has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Joe Jones Law Firm. Dr. Piquet has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Cortez & Associates. Dr. Piquet has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Falk Waas. The institution of Dr. Piquet has received research support from Rocky Mountain MS Center. The institution of Dr. Piquet has received research support from Roche/Genentech. The institution of Dr. Piquet has received research support from NYU. The institution of Dr. Piquet has received research support from Anokion. The institution of Dr. Piquet has received research support from UCB . The institution of Dr. Piquet has received research support from Foundation for Sarcoidosis. The institution of Dr. Piquet has received research support from Kyverna . Dr. Piquet has received publishing royalties from a publication relating to health care. Dr. Piquet has received publishing royalties from a publication relating to health care. Dr. Piquet has received personal compensation in the range of $10,000-$49,999 for serving as a Litigative Consultant with US-Dept HHS/DICP. Dr. Piquet has a non-compensated relationship as a Medical Advisory Board Member with Autoimmune Encephalitis Alliance (AEA) that is relevant to AAN interests or activities. Dr. Piquet has a non-compensated relationship as a Medical Advisory Board Member with Stiff Person Syndrome Research Foundation (SPSRF) that is relevant to AAN interests or activities.

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