Acute Myelitis Secondary to COVID-19 in an Adolescent: Causality or Coincidence ?

Abstract

Coronavirus disease 2019 (COVID-19) first emerged in Wuhan, China in December 2019. Headache, dizziness, attenuated taste/smell, stroke, acute disseminated encephalomyelitis, encephalitis, Guillain-Barré syndrome, and myelitis are rare neurological symptoms and complications reported in adults. A 14-year-old girl presented with sudden-onset loss of strength in her right arm and leg. A nasopharyngeal swab was collected because the patient had a history of suspicious contact with a confirmed COVID-19 patient. SARS-CoV-2 nucleic acid testing of the patient’s nasopharyngeal swab was positive. Her clinical presentation suggested transverse myelitis. On spinal MRI, a contrast-enhancing lesion causing expansion at the C2-C5 level was observed. On day 5 of pulse methylprednisolone treatment, the patient had 3/5 muscle strength in her right upper extremity and 5/5 muscle strength in her right lower extremity. This case emphasizes that during the pandemic, SARS-CoV-2 must be considered as the etiology in children presenting with neurological involvement if there is a history of contact.

Keywords

• Acute Myelitis
• COVID-19
• Child

References

1. Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382:727-733
2. Park SE. Epidemiology, virology, and clinical features of severe acute respiratory syndrome -coronavirus-2 (SARS-CoV-2; Coronavirus Disease-19). Clin Exp Pediatr. 2020, 63: 119‐124. doi:10.3345/cep.2020.00493
3. Mehmet Şahin. Impact of weather on COVID-19 pandemic in Turkey. Science of the Total Environment 728 (2020) 138810 doi.org/10.1016/j.scitotenv.2020.1388100048-9697
4. Bialek S, Gierke R, Hughes M, et al. Coronavirus Disease 2019 in Children United States, February 12–April 2, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:422-426.
5. YeshunWu, Xiaolin Xu, Zijun Chen, et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain, Behavior, and Immunity. https://doi.org/10.1016/j.bbi.2020.03.031
6. Werner C, Scullen T, Mathkour M, et al. Neurological Impact of Coronavirus Disease (COVID-19): Practical Considerations for the Neuroscience Community. World Neurosurgery. 2020;139:344-354. doi: https://doi.org/10.1016/j.wneu.2020.04.222.
7. Moriguchi T, Harii N, Goto J, et al. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis. 2020;94:55-58
8. Consuelo Gutiérrez-Ortiz, Antonio Méndez, Sara Rodrigo-Rey, et al. Miller Fisher Syndrome and polyneuritis cranialis in COVID-19. Neurology (2020). doi: 10.1212/WNL.0000000000009619

9. Zhao H, Shen D, Zhou H, et al. Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence? Lancet Neurology. 2020 https://doi.org/10.1016/ S1474-4422(20)30109-5
10. Zhao K, Huang J, Dai D, Feng Y, et al. Acute myelitis after SARS-CoV-2 infection: a case report doi: https://doi.org/10.1101/2020.03.16.20035105
11. Y. Ogata, W. Nemoto, R. Yamagata. Anti-Hypersensitive Effect of Angiotensin (1-7) on Streptozotocin-Induced Diabetic Neuropathic Pain in Mice. Eur J Pain. 2019;23:739-749 doi: 10.1002/ejp.1341.
12. Varina L. Wolf, Pamela J. Lupo, Timothy E. Lotze. Pediatric Acute Transverse Myelitis Overview and Differential Diagnosis. Journal of Child Neurology. 2012;27:1426-1436 doi:10.1177/0883073812452916
13. T.W. West, C. Hess, B.A. Cree. Acute Transverse Myelitis: Demyelinating, Inflammatory, and Infectious Myelopathies. Semin Neurol. 2012;32:97-113 doi: 10.1055 / s-0032-1322586.
14. Ye M, Ren Y, Lv T. Encephalitis as a clinical manifestation of COVID-19. Brain Behav Immun. 2020; S0889-1591(20)30465-7. doi:10.1016/j.bbi.2020.04.017
15. Yeh EA, Collins A, Cohen ME, et al. Detection of coronavirus in the central nervous system of a child with acute disseminated encephalomyelitis. Pediatrics. 2004;113(1 Pt 1):e73‐e76. doi:10.1542/peds.113.1.e73
16. Ellul M, Benjamin L, Singh B, Lant S, Michael BD, Easton A, et al. "Neurological Associations of COVID-19." Lancet Neurol 2020, Published Online July 2, 2020 https://doi.org/10.1016/ S1474-4422(20)30221-0