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Pediatric acute disseminated encephalomyelitis following asymptomatic coronavirus disease 2019

Yuta Nakamura1, Takahiro Namba1, Yukiko Kawazu1

  • 1Department of Pediatrics, Fukuyama City Hospital, Fukuyama, Japan.

Idcases
|May 3, 2024
PubMed

Insights

A 5-year-old boy developed acute disseminated encephalomyelitis (ADEM) during a subacute, asymptomatic infection with SARS-CoV-2. This case highlights ADEM as a potential neurological complication of COVID-19, even without acute symptoms.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Pediatrics

Background:

  • The emergence of SARS-CoV-2 has led to widespread outbreaks of COVID-19.
  • Neurological complications, including central nervous system (CNS) involvement, can occur in patients with severe COVID-19 during the acute phase.

Observation:

  • A 5-year-old boy presented with acute disseminated encephalomyelitis (ADEM) with initial symptoms of dysphoria and right lower extremity pain.
  • The patient had no fever or respiratory symptoms during the episode.
  • Brain and spinal MRI revealed extensive white matter lesions and central gray matter lesions, respectively.
  • Tests were negative for aquaporin-4 antibodies but positive for myelin oligodendrocyte glycoprotein antibodies.
  • A nasopharyngeal swab was positive for SARS-CoV-2 via PCR.

Findings:

  • This case represents the first reported instance of ADEM in the subacute phase of COVID-19 in a patient lacking acute symptoms.
  • The findings suggest that ADEM can be a sequela of asymptomatic SARS-CoV-2 infection.

Implications:

  • ADEM should be considered in the differential diagnosis of new-onset neurological disorders, particularly in the context of COVID-19.
  • This case expands the understanding of the spectrum of neurological manifestations associated with SARS-CoV-2 infection.
  • Further research is warranted to elucidate the mechanisms linking SARS-CoV-2 to ADEM and to identify potential biomarkers for early detection and intervention.

Keywords:
Acute disseminated encephalomyelitisCoronavirus disease 2019Magnetic resonance imagingMyelin-oligodendrocyte glycoprotein antibodyPediatricSevere acute respiratory syndrome coronavirus 2

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