ADEM post-Sars-CoV-2 infection in a pediatric patient with Fisher-Evans syndrome

• Published in: Neurological sciences 2021-10, Vol.42 (10), p.4293-4296
• Main Authors: Manzo, Maria Laura, Galati, Cristina, Gallo, Cristina, Santangelo, Giuseppe, Marino, Antonio, Guccione, Fulvio, Pitino, Renata, Raieli, Vincenzo
• Format: Article
• Language: English
• Subjects: Anemia, Hemolytic, Autoimmune; Brief Communication; Child; COVID-19; EEG; Encephalomyelitis; Encephalomyelitis, Acute Disseminated - diagnostic imaging; Encephalomyelitis, Acute Disseminated - drug therapy; Encephalomyelitis, Acute Disseminated - etiology; Humans; Immunosuppressive agents; Infections; Magnetic resonance imaging; Male; Medicine; Medicine & Public Health; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Patients; Pediatrics; Psychiatry; Rapamycin; RNA viruses; RNA, Viral; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Thalidomide; Thrombocytopenia
• ISSN: 1590-1874; 1590-3478
• DOI: 10.1007/s10072-021-05311-1

Introduction Sars-CoV-2 is a single-strained RNA virus belonging to Coronaviridae’s family. In pediatric age, the majority of patients is asymptomatic; however, several neurological manifestations associated with Sars-CoV-2 infection have been detected in a percentage of cases ranging from 17.3 to 36.4%. Acute disseminated encephalomyelitis (ADEM) has been recently included among the potential complications of Sars-Cov2 infection. The available data regarding pediatric patient show only one case. Case report We present a case regarding a 6-year-old patient suffering from Fisher-Evans syndrome who was given sirolimus and thalidomide therapy. After 10 days since the first positive nasopharyngeal swab for Sars-CoV-2, in which he had no symptoms, he presented an episode of generalized tonic-clonic seizure with spontaneous resolution. The patient underwent MRI which showed the typical picture of acute disseminated encephalomyelitis. His clinical course was favorable, with a good response to cortisone therapy and a progressive improvement of the neuroradiological and electroencephalographic picture. Conclusions According to our knowledge, this is the second case of an acute disseminated encephalomyelitis following SARS-CoV-2 infection in a pediatric patient, characterized by monosymptomatic onset, in which the immunosuppressive therapy practiced for the Fisher-Evans syndrome has probably contributed to a favorable evolution of ADEM, in contrast to other case described in the literature.