Abstract General Information
MULTIPLE SCLEROSIS WITH ADEM-LIKE ONSET IN A CHILD POST-COVID-19.
Case report: A 9-year-old male patient presented with acute left hemiparesis two months after COVID-19. Brain MRI showed multiple T2/FLAIR hyperintense lesions in the cerebral hemispheres and corpus callosum with contrast enhancement, suggestive of demyelination. CSF was normal. The main diagnostic hypothesis was acute disseminated encephalomyelitis (ADEM), and six sessions of pulse therapy with methylpredinosolone were performed with complete recovery, followed by maintenance oral corticosteroid therapy.
One month after discontinuing the corticosteroid, the patient developed severe visual impairment in the right eye. Five sessions of pulse therapy and five sessions of plasmapheresis were performed, with visual improvement. One year after the first attack, the neurological examination showed visual acuity of 20/25 in both eyes, and Ishihara test results of 1/10 in the RE and 10/10 in the LE.
Screening for infectious, rheumatologic, and metabolic disorders was negative, as were anti-aquaporin 4 and anti-MOG antibodies. A new CSF examination showed the presence of oligoclonal bands and the appearance of new T2/FLAIR and contrast-enhancing T1 lesions. The diagnosis of relapsing-remitting multiple sclerosis was established, and treatment was initiated.
Discussion: In this case, the patient presented an ADEM-like syndrome as the first manifestation of MS, probably triggered by COVID-19 infection. Recent literature suggests a possible invasion of the central nervous system (CNS) by SARS-CoV-2, that could cause various neurological manifestations, such as ADEM. The pediatric group is the most affected by ADEM, and it is one of the main initial clinical manifestations of MS in childhood (19 to 24%).
Final comments: Children with a first episode of ADEM-like syndrome should be monitored for the possibility of MS. The SARS-CoV-2 infection in this case may have been a trigger for the development of the disease. More studies are necessary to investigate potential neurological complications of COVID-19 infection in children.
Juliana Santiago Amaral, Juliana Monçao, Ana Cristina Cotta Queiroz, Beatriz Silva Lombardi , Clara Catharino Pinhati, Cleison Sanches Silva, Gabriel Coelho, Denison Pedrosa, Grazielle Fialho de Souza, Hugo Brito, Emerson Costa Oliveira, Felipe Baptista Brunheroto, Lucas Bittar Sesso Freitas, Larissa Ferrarez, Márcia Prates, Natália Cirino Talim, Paulo Pereira Christo, Pedro L. B. dos Reis, Thales Ponsa, Marco Aurelio Lana-Peixoto