ABSTRACT
Importance: Coronavirus disease 2019 (COVID-19) affects the nervous system in adult patients. The spectrum of neurologic involvement in children and adolescents is unclear. Objective: To understand the range and severity of neurologic involvement among children and adolescents associated with COVID-19. Setting, Design, and Participants: Case series of patients (age <21 years) hospitalized between March 15, 2020, and December 15, 2020, with positive severe acute respiratory syndrome coronavirus 2 test result (reverse transcriptase-polymerase chain reaction and/or antibody) at 61 US hospitals in the Overcoming COVID-19 public health registry, including 616 (36%) meeting criteria for multisystem inflammatory syndrome in children. Patients with neurologic involvement had acute neurologic signs, symptoms, or diseases on presentation or during hospitalization. Life-threatening involvement was adjudicated by experts based on clinical and/or neuroradiologic features. Exposures: Severe acute respiratory syndrome coronavirus 2. Main Outcomes and Measures: Type and severity of neurologic involvement, laboratory and imaging data, and outcomes (death or survival with new neurologic deficits) at hospital discharge. Results: Of 1695 patients (909 [54%] male; median [interquartile range] age, 9.1 [2.4-15.3] years), 365 (22%) from 52 sites had documented neurologic involvement. Patients with neurologic involvement were more likely to have underlying neurologic disorders (81 of 365 [22%]) compared with those without (113 of 1330 [8%]), but a similar number were previously healthy (195 [53%] vs 723 [54%]) and met criteria for multisystem inflammatory syndrome in children (126 [35%] vs 490 [37%]). Among those with neurologic involvement, 322 (88%) had transient symptoms and survived, and 43 (12%) developed life-threatening conditions clinically adjudicated to be associated with COVID-19, including severe encephalopathy (n = 15; 5 with splenial lesions), stroke (n = 12), central nervous system infection/demyelination (n = 8), Guillain-Barré syndrome/variants (n = 4), and acute fulminant cerebral edema (n = 4). Compared with those without life-threatening conditions (n = 322), those with life-threatening neurologic conditions had higher neutrophil-to-lymphocyte ratios (median, 12.2 vs 4.4) and higher reported frequency of D-dimer greater than 3 µg/mL fibrinogen equivalent units (21 [49%] vs 72 [22%]). Of 43 patients who developed COVID-19-related life-threatening neurologic involvement, 17 survivors (40%) had new neurologic deficits at hospital discharge, and 11 patients (26%) died. Conclusions and Relevance: In this study, many children and adolescents hospitalized for COVID-19 or multisystem inflammatory syndrome in children had neurologic involvement, mostly transient symptoms. A range of life-threatening and fatal neurologic conditions associated with COVID-19 infrequently occurred. Effects on long-term neurodevelopmental outcomes are unknown.
Subject(s)
COVID-19/complications , Nervous System Diseases/etiology , Systemic Inflammatory Response Syndrome/etiology , Adolescent , COVID-19/etiology , COVID-19/mortality , Child , Child, Preschool , Critical Care , Female , Hospitalization , Humans , Male , Nervous System Diseases/mortality , Patient Discharge/statistics & numerical data , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapy , Systemic Inflammatory Response Syndrome/complications , Treatment Outcome , United States/epidemiologyABSTRACT
We report the case of an 11-year-old male adolescent, with symptoms of MISC-PIMS, negative RT-PCR and negative serology for COVID-19, family contact RT-PCR positive for COVID-19, treated in a referral hospital center, receiving treatment standardized for MIS-C, without response to initial therapy, despite receiving the same scheme on 3 occasions, classified as refractory, for which an expanded study was decided for other entities; finding hemophagocytic lymphohistiocytosis associated with systemic lupus erythematosus, an entity that often share similar inflammatory markers with the MISC, even usually confused with rheumatological, hematological and neoplastic entities, therefore the importance of reporting the case to identify this group refractory to treatment and identify another disease with expanded study, since it could be harmful or even fatal if a definitive diagnosis is not obtained.
Reportamos el caso de un adolescente varón de 11 años, con clínica de MISC-PIMS, RT-PCR negativa y serología negativa para COVID-19, contacto familiar RT-PCR positiva para COVID-19, atendido en un centro hospitalario referencial, recibiendo tratamiento estandarizado para MIS-C, sin respuesta a la terapéutica inicial, a pesar de recibir en 3 oportunidades el mismo esquema, catalogado como refractario, por lo que se decide estudio ampliado para otras entidades; encontrándose Linfohistiocitosis hemofagocítica asociada a Lupus eritematoso sistémico, entidad que muchas veces comparten marcadores inflamatorios similares con el MISC, inclusive usualmente confundida con entidades reumatológicas, hematológicas y neoplásicas, por eso la importancia de reportar el caso para identificar este grupo refractario al tratamiento e identificar otra enfermedad con estudio ampliado, ya que podría ser perjudicial hasta inclusive mortal si no se obtiene un diagnostico definitivo.
