Novel SARS-CoV-2 originated in Wuhan, China in December 2019 and became a global threat within months. Many associated complications including neurological disorders have been identified. Post-Infectious complications such as Multisystem Inflammatory syndrome in Children (MIS-C), Acute disseminated encephalomyelitis have been described. Here we present the first case of a 7-year-old female with a prior asymptomatic infection with SARS-CoV-2 who subsequently developed encephalopathy and status epilepticus in association with MOG antibody positivity.

Previously healthy, 7-year-old female presented acutely with status epilepticus, aphasia, fever, encephalopathy and prolonged Todd’s paralysis. CSF with lymphocytic pleocytosis and elevated protein. Neuroimaging revealed peri Rolandic and posterior parietal lobe restricted diffusion and cortical edema. EEG demonstrated cerebral slowing with left focal slowing. Of note, SARS-CoV-2 PCR was negative in the serum and CSF although IgG levels were not obtained. Following anti-convulsant therapy, she returned to her neurocognitive baseline and  discharged in  two days.

Following week she was readmitted with headaches, encephalopathy, abdominal pain, dysarthria/slurred speech and altered mental status. Repeat MRI brain showed previous diffusion restriction and cortical edema was less apparent. CSF lymphocytic pleocytosis, serum SARS-CoV-2 antibodies revealed a titer of 7.1. The patient was also found to be MOG antibody positive with titer of 1:100. For presumed post-infectious neurologic phenomenon, the patient was administered intravenous immunoglobulin (IVIg) 2 g/kg over three days. She showed improvement in her condition over five days and was discharged home with no further seizures. Upon follow up she had almost returned to her baseline with mild dysarthria.

Two important factors are identified here, First, the potential link between prior SARS-CoV-2 infection and the subsequent development of neuroinflammatory disease. Second this is of greater importance in pediatric patients as there may be no overt respiratory phenomenon with initial infection thus an important consideration for Neurologist and Pediatricians.