Lethal Pediatric Cerebral Vasculitis Triggered by Severe Acute Respiratory Syndrome Coronavirus 2
| Autor: | David B. Haslam, Barbara Hallinan, Marissa Vawter-Lee, Charles B. Stevenson, Tracy V. Ting, Gwendolyn M. Clay, Kelsey E. Poisson, Monica M. McNeal, Blaise V. Jones, Shannon M. Standridge, Alexander Zygmunt, Melissa E. Day, Kristen Wesselkamper, Daniel Leino, Mary Allen Staat, Christine Fuller |
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| Rok vydání: | 2022 |
| Předmět: |
Weakness
Pathology medicine.medical_specialty medicine.diagnostic_test business.industry Magnetic resonance imaging Autopsy medicine.disease Lesion Cerebrospinal fluid Developmental Neuroscience Neurology Pediatrics Perinatology and Child Health medicine Etiology Neurology (clinical) medicine.symptom Vasculitis business Cerebral vasculitis |
| Zdroj: | Pediatric Neurology. 127:1-5 |
| ISSN: | 0887-8994 |
| Popis: | Objectives We report the clinical, radiological, laboratory, and neuropathological findings in support of the first diagnosis of lethal, small-vessel cerebral vasculitis triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a pediatric patient. Patient description A previously healthy, 8-year-old Hispanic female presented with subacute onset left-sided weakness two weeks after a mild febrile illness. SARS-CoV-2 nasopharyngeal swab was positive. Magnetic resonance imaging (MRI) revealed an enhancing right frontal lobe lesion with significant vasogenic edema. Two brain biopsies of the lesion showed perivascular and intraluminal lymphohistiocytic inflammatory infiltrate consistent with vasculitis. Despite extensive treatment with immunomodulatory therapies targeting primary angiitis of the central nervous system, she experienced neurologic decline and died 93 days after presentation. SARS-CoV-2 testing revealed positive serum IgG and positive cerebrospinal fluid IgM. Comprehensive infectious, rheumatologic, hematologic/oncologic, and genetic evaluation did not identify an alternative etiology. Post-mortem brain autopsy remained consistent with vasculitis. Discussion This is the first pediatric presentation to suggest SARS-CoV-2 can lead to a fatal, post-infectious, inflammatory small-vessel cerebral vasculitis. Our case is unique in including supportive cerebrospinal fluid and post-mortem tissue analysis. While most children recover well from neurologic complications of SARS-CoV-2, we emphasize the potential mortality in a child with no risk factors for severe disease. |
| Databáze: | OpenAIRE |
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