Abstract Details

Title SARS-CoV-2 infection: a potential trigger of inflammatory neurological disorders

Topic Autoimmune Neurology

Presentation(s) Autoimmune Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 003

Objective To assess Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) specific IgA/G seropositivity in patients with suspected autoimmune central nervous system (CNS) disorders.

Background

Inflammatory/autoimmune disorders can be triggered by viral infections, as described in patients with antibodies to neuronal surface proteins or myelin oligodendrocyte glycoprotein (MOG). Whether SARS-CoV-2 infection induces such conditions is unknown, although widely hypothesised.

Design/Methods

We retrospectively analysed consecutive samples referred for antibody screening to the Neuropathology Laboratory, Verona, for SARS-COV-2 IgA and IgG testing, from March 1^st 2020 to August 31^st 2020. Clinical information of seropositive cases was extracted from clinical records or provided by referring physicians.

Results Among 332 patients referred for antibody testing, 26 showed either SARS-CoV-2 IgA and/or IgG (IgA n=12, IgG n=1, IgA and IgG n= 13). Among 22/26 available CSF, 4 were positive (IgG n=3, IgG and IgA n=1). Median age of seropositive cases was 61 years (range 27-82) and 16 were female. Clinical features, available in 23 cases, revealed encephalopathy (n=15) and seizures (n=8) as common manifestations and, in four cases, myelitis, predominantly with lower limbs weakness. 19/23 patients were systemically asymptomatic. Brain MRI showed FLAIR-T2 hyperintensities in 13/18 patients. EEG showed alterations including epileptic discharges (n=5) and/or generalized slowing (n=12). CSF pleocytosis (>5 cells/µL) was reported in 9/19 investigated cases. Autoimmune neurology screening revealed one patient with serum titin autoantibodies, one with limbic encephalitis and seizures had serum and CSF amphiphysin antibodies, and one presenting with acute disseminated encephalomyelitis had serum and CSF MOG antibodies.

Conclusions

The incidence of SARS-CoV-2 IgG/IgA positivity in our referred cohort, which was higher (7.8%, 18% when considering only patients with suspected encephalitis) than that reported in the Italian population (2.5%) and the observed clinical spectrum of disorders suggest that SARS-CoV2 could trigger inflammatory CNS processes, usually not associated with well-known autoantibodies. Case-control studies are now required.

Authors/Disclosures
PRESENTER	No disclosure on file
Sarosh R. Irani, MD, PhD, FRCP, FEAN (Mayo Clinic)	Dr. Irani has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for AZ, Roche, Cerebral therapeutics, Biogen, Amgen, Argenex, Clarivate, IQVIA, BioHaven therapeutics.. Dr. Irani has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Brain. Dr. Irani has received intellectual property interests from a discovery or technology relating to health care. Dr. Irani has received intellectual property interests from a discovery or technology relating to health care.
Andrew McKeon, MD (Mayo Clinic)	The institution of Dr. McKeon has received research support from National Institutes of Health. Dr. McKeon has received intellectual property interests from a discovery or technology relating to health care. Dr. McKeon has received intellectual property interests from a discovery or technology relating to health care. Dr. McKeon has received publishing royalties from a publication relating to health care.
Andrea Pilotto	Andrea Pilotto has nothing to disclose.
Alessandro Padovani, MD	No disclosure on file
Eugenio Magni, MD	Dr. Magni has nothing to disclose.
	No disclosure on file
Ruggero Capra, MD	Dr. Capra has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Sara Mariotto, MD, PhD (Neurology Unit, University of Verona)	Dr. Mariotto has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen, Sanofi, Alexion, Roche, TSF, Dynamics, UCB, Novartis, Amgen, AAN. The institution of Dr. Mariotto has received research support from Ministero della Salute Italiano. The institution of Dr. Mariotto has received research support from TSF. The institution of Dr. Mariotto has received research support from GJF. The institution of Dr. Mariotto has received research support from Lundbeck. The institution of Dr. Mariotto has received research support from Euroimmun. The institution of Dr. Mariotto has received research support from FISM.

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