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Updated: Nov 11, 2025
Induction and Clinical Scoring of Chronic-Relapsing Experimental Autoimmune Encephalomyelitis
Published on: July 4, 2007
Post-COVID-19 Acute Disseminated Encephalomyelitis in a 17-Month-Old
Loren A McLendon1,2, Chethan K Rao1,2, Cintia Carla Da Hora3
1Division of Child and Adolescent Neurology, Mayo Clinic College of Medicine and Science, Jacksonville, Florida.
Insights
This study reports the youngest case of acute disseminated encephalomyelitis (ADEM) in a toddler following SARS-CoV-2 infection. Early immunomodulatory treatment led to a full neurologic recovery, highlighting the importance of recognizing these complications.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Immunology
Background:
- Neurologic complications of SARS-CoV-2 infection can occur in children during acute and postinfectious phases.
- Acute disseminated encephalomyelitis (ADEM) typically follows viral illness in children aged 3-7 years, with most experiencing minimal long-term deficits.
- This case presents a unique instance of ADEM in a much younger child.
Abstract:
Neurologic manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pediatric patients have been reported in the acute and postinfectious stages of coronavirus disease 2019. Acute disseminated encephalomyelitis (ADEM) typically presents in children after a viral illness at a mean age of 3 to 7 years. A total of 60% to 90% of literature-reported pediatric patients with ADEM have minimal to no neurologic deficits at long-term follow-up. We present a 17-month-old developmentally typical girl with parental complaints of irritability, upper extremity weakness, and gait disturbance. She presented to the hospital afebrile and irritable with right-sided nasolabial fold flattening, neck stiffness, left upper extremity rigidity, right upper extremity paresis, bilateral lower extremity hyperreflexia, and truncal ataxia. During her hospital course, she became somnolent with autonomic instability and was transferred to intensive care. Contrasted brain MRI revealed diffuse patchy T2 hyperintensities without contrast enhancement. Nasopharyngeal SARS-CoV-2 polymerase chain reaction and serum antibody testing results were positive. Cerebral spinal fluid analysis was unremarkable. Respiratory viral panel and autoimmune encephalitis and demyelinating disorders panel results were negative. She was started on high-dose methylprednisolone and intravenous immunoglobulin, with improvement in mental status, focal deficits, and ambulation. After hospital discharge, she received inpatient rehabilitation for 2 weeks and at 2 month follow-up had a full neurologic recovery. We report the youngest case of postinfectious ADEM due to SARS-CoV-2 in a toddler. Early recognition of autoimmune and inflammatory complications of SARS-CoV-2 is vital for early aggressive immunomodulatory treatment and, consequently, improved morbidity in these patients.
