Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA.
Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA; Department of Neurology, Keck School of Medicine at the University of Southern California, Los Angeles, CA 90033, USA.
Mult Scler Relat Disord. 2021 May;50:102855. doi: 10.1016/j.msard.2021.102855. Epub 2021 Feb 23.
The global pandemic of SARS-CoV-2 has been known to have diverse neurologic complications among adult patients. The neurologic effects of SARS-CoV-2 in the pediatric population is poorly described, especially in those with rare underlying neurologic conditions. We describe the first known case of SARS-CoV-2 in a pediatric patient with refractory opsoclonus-myoclonus syndrome. A 25-month-old female with progressive opsoclonus-myoclonus syndrome secondary to metastatic neuroblastoma status-post resection and chemotherapy presented with worsening opsoclonus, tremor, and breakthrough seizures. She had no fever or respiratory symptoms at presentation. Urine catecholamines were unchanged, with low suspicion for tumor recurrence. She was found to have SARS-CoV-2 via nasopharnygeal PCR assay. She received intravenous immunoglobulin and dexamethasone therapy with improvement in opsoclonus-myoclonus syndrome symptoms and was discharged home at her neurologic baseline. Patients with opsoclonus-myoclonus syndrome may present with exacerbation of symptoms in the context of SARS-CoV-2. This case describes a sentinel report of a child with opsoclonus-myoclonus syndrome presenting with worsening symptoms with concomitant SARS-CoV-2. Improvement in symptoms was achieved with standard of care therapies.
SARS-CoV-2 全球大流行已被证实可导致成年患者出现多种神经系统并发症。SARS-CoV-2 对儿科人群的神经系统影响描述甚少，尤其是在那些伴有罕见潜在神经系统疾病的患儿中。我们描述了首例已知的 SARS-CoV-2 感染合并难治性眼-口-肌阵挛综合征的儿科患者。一名 25 月龄的女性，因转移性神经母细胞瘤行切除和化疗后继发难治性眼-口-肌阵挛综合征，出现进行性眼-口-肌阵挛、震颤和突破性癫痫发作。就诊时无发热或呼吸道症状。尿儿茶酚胺未见变化，肿瘤复发的可能性较低。通过鼻咽拭子 PCR 检测发现 SARS-CoV-2 阳性。给予静脉注射免疫球蛋白和地塞米松治疗后，眼-口-肌阵挛综合征症状改善，患儿出院时神经系统状态恢复基线水平。眼-口-肌阵挛综合征患者可能因 SARS-CoV-2 出现症状恶化。本病例描述了一例以眼-口-肌阵挛综合征症状加重为表现的患儿，同时合并 SARS-CoV-2 感染。经标准治疗后症状改善。
