COVID-19 Associated leukoencephalopathy in a term neonate: imaging findings and clinical presentation

A 5-day old neonate presented with several episodes of seizure-like activity associated with hypoxia. The episodes were responsive to anti-epileptic medications and the infant was given empiric antibiotics and antiviral coverage. Cerebrospinal fluid polymerase chain reaction (PCR), culture, and gram stain were negative for viral or bacterial etiology. However, a nasopharyngeal PCR of the infant was positive for SARS-COV-2. While head computed tomography (CT) was negative, magnetic resonance imaging (MRI) showed evidence of white matter injury in the subcortical and periventricular regions and corpus callosum. With supportive therapies, the infant made a full neurologic recovery and was discharged following a 5-day admission. This case highlights the growing evidence of SARS-COV-2 associated leukoencephalopathy in neonates, and physicians should consider this diagnosis in neonates with similar presentation.