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Pseudotumor Cerebri Complicating Multisystem Inflammatory Syndrome in a Child
Karuppannasamy Divya1, Chellappan Indumathi2, Kanagaraju Vikrant3
1Department of Ophthalmology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
Insights
Pseudotumor cerebri (PTC) can occur in children with multisystem inflammatory syndrome in children (MIS-C), a condition linked to COVID-19. Early diagnosis and treatment of this neuro-ophthalmic complication are crucial for preventing vision loss.
Area of Science:
- Pediatric Neurology
- Ophthalmology
- Infectious Diseases
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a serious condition associated with COVID-19.
- Neuro-ophthalmic complications, such as pseudotumor cerebri (PTC), are increasingly recognized in pediatric inflammatory syndromes.
Observation:
- A previously healthy 11-year-old female presented with symptoms suggestive of MIS-C, including fever, headache, vomiting, and gastrointestinal issues.
- Ophthalmic evaluation revealed bilateral optic disc swelling, indicative of increased intracranial pressure.
- Cerebrospinal fluid analysis showed elevated opening pressure (336 mm H2O) without pleocytosis, consistent with PTC.
Findings:
- The child was diagnosed with pseudotumor cerebri (PTC) in the context of multisystem inflammatory syndrome in children (MIS-C).
- Treatment with acetazolamide led to the regression of optic disc edema.
- The patient's visual symptoms resolved, and she is currently under ongoing follow-up.
Implications:
- This case highlights a potential neuro-ophthalmic complication of MIS-C.
- Awareness among clinicians of the association between MIS-C and PTC is critical for timely diagnosis.
- Prompt management of PTC in MIS-C patients can prevent irreversible visual impairment.
Purpose:
To report a case of pseudotumor cerebri (PTC) in a child associated with multisystem inflammatory syndrome in children (MIS-C), associated with presumed coronavirus disease 2019.
Methods:
A previously healthy 11-year-old female child presented with a 4-day history of fever, headache, vomiting, and loose stools. Laboratory investigations revealed neutrophilic leukocytosis, and markers of inflammation (C-reactive protein, ferritin, and interleukin-6) were significantly elevated. Pharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by polymerase chain reaction was negative while anti-SARS-CoV-2 antibody was highly reactive. Ophthalmic evaluation for transient visual obscurations during hospital course revealed swelling of the optic disc in both eyes. Spectral-domain optical coherence tomography and ultrasonography confirmed the ophthalmoscopic findings. There was no neurologic deficit. Magnetic resonance imaging of the brain and magnetic resonance venogram revealed no structural lesion. The opening pressure of cerebrospinal fluid (CSF) was 336 mm of water, and CSF composition was normal.
Results:
A diagnosis of PTC associated with MIS-C was made, and the child was treated with oral acetazolamide. Edema of the optic disc regressed following therapy, and the child is under follow-up.
Conclusions:
PTC can occur in association with MIS-C. Clinicians need to be aware of this potential neuro-ophthalmic complication in MIS-C. Prompt diagnosis and treatment can prevent visual loss.
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