Abstract Details

Title Refractory Acute Disseminated Encephalomyelitis-like Findings in a Pediatric Patient in the Setting of SARS-CoV-2 with Histopathology

Topic Autoimmune Neurology

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

Poster/Presentation
Number 010

Objective 5-year-old boy with ADEM-like syndrome in the setting of SARS-CoV-2.

Background Acute disseminated encephalomyelitis (ADEM) is an autoimmune demyelinating syndrome of the central nervous system that usually occurs following a febrile illness. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) is predominantly a respiratory disease, but it is becoming increasingly recognized to have neurological manifestations. There have been few reported cases of ADEM in adults related to SARS-CoV-2, but none in the pediatric population.

Design/Methods Clinical course, neuroimaging, and histopathology results description.

Results A 5-year-old boy presented with 3 weeks of headaches, blurry vision, and emesis. Initial evaluation was unremarkable except for positive SARS-CoV-2 RNA PCR from nasopharyngeal swab. Patient returned to the ED for persistent symptoms. MRI brain demonstrated supratentorial and infratentorial enhancing lesions, with vasogenic edema and punctate hemorrhage foci, and bilateral optic nerve swelling. MRI spine revealed longitudinally extensive myelitis. Brain biopsy was pursued showing foci of lymphohistiocytic perivascular inflammation consistent with a meningoencephalitis. ADEM was suspected and high dose intravenous methylprednisolone was initiated. CSF revealed lymphocytic pleocytosis. Extensive evaluation including Myelin oligodendrocyte glycoprotein and Aquaporin-4 antibodies was unremarkable. Given limited clinical improvement, patient received 5 sessions of plasmapheresis with improvement. He returned a week later with headache. Repeat MRI brain revealed mild hydrocephalus. He received a 5-day course of high dose steroids followed by 6-week steroid taper. Patient remained clinically stable, however, surveillance MRI brain 2-months later revealed worsening cerebellar edema and hydrocephalus so he received another 5-day course of steroids and intravenous immunoglobulins.

Conclusions This is the first presentation to our knowledge of pediatric ADEM-like in the setting of SARS-CoV-2 with a medically refractory course. This case highlights the importance of recognizing neurological manifestations of SARS-COV-2. Given the novelty of the virus, the inflammatory process triggered by this infection may follow a different clinical course, therefore close monitoring is recommended.

Authors/Disclosures
Jocelyn B. Lorenzo, MD (Our Lady of the Lake Children's Hospital) PRESENTER	Dr. Lorenzo has nothing to disclose.
Natalia Gonzalez Caldito, MD (home)	Dr. Gonzalez Caldito has nothing to disclose.
Cynthia X. Wang, MD (Children's Dallas Neurology)	Dr. Wang has nothing to disclose.

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