Department of Surgery and High Intensity of Care, Sub-intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Liguria, Italy.
Department of Medical Surgical and Experimental Sciences, Unit of Child Neuropsychiatry, University Hospital of Sassari, Sassari, Sardegna, Italy.
Neuropediatrics. 2022 Feb;53(1):61-64. doi: 10.1055/s-0041-1732364. Epub 2021 Jul 29.
In the last few months, some pediatric cases with neurological and neuroradiological pictures related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections have been reported, often associated with multisystem inflammatory syndrome (MIS-C). The most frequently encountered pediatric neurological complications seem to be postinfectious immune-mediated acute disseminated encephalomyelitis (ADEM)-like changes of the brain, myelitis, neural enhancement, and splenial lesions. Concomitant neurological and cardiac involvement has been reported only in MIS-C, although specific clinical details are often not fully available.
In this case report, a very young child infected with SARs-CoV-2 and diagnosed as longitudinal extensive transverse myelitis with concomitant myo-pericarditis is presented.
A previously healthy 7-month-old girl presented with abrupt onset of generalized weakness with inability to sit up. She had had mild respiratory symptoms 1 week earlier. Spinal magnetic resonance imaging (MRI) showed a T2-hyperintense intramedullary lesion extending from C4 to T2, compatible with acute longitudinally extensive transverse myelitis (LETM). Cerebrospinal fluid analysis was negative.Echocardiography and blood tests were suggestive for myo-pericarditis. Real time polymerase chain reaction for SARS-CoV-2 on nasopharyngeal swab sample tested positive. She was promptly treated with high dose of steroids and immunoglobulin with satisfactory clinical response.
To the evolving literature of neurological complications of SARs-CoV-2 infection, we add the youngest patient described to date with isolated LETM and concomitant cardiac involvement. Our case suggests that clinicians should be aware of this association, although difficult to recognize in infants. Practitioners are encouraged to consider aggressive first-line immunotherapies with the final aim to prevent permanent disability.
在过去的几个月中，已经报道了一些与严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 感染相关的具有神经和神经放射学表现的儿科病例，这些病例常伴有多系统炎症综合征 (MIS-C)。最常遇到的儿科神经并发症似乎是感染后免疫介导的急性播散性脑脊髓炎 (ADEM)样脑改变、脊髓炎、神经增强和胼胝体病变。虽然通常无法提供完整的具体临床细节，但仅在 MIS-C 中报告了同时存在神经和心脏受累的情况。
在本病例报告中，介绍了一例感染 SARS-CoV-2 的非常年幼的儿童，其诊断为伴有心肌炎的纵向广泛横贯性脊髓炎。
一名之前健康的 7 个月大女孩突然出现全身无力，无法坐起。她在 1 周前有轻度呼吸道症状。脊髓磁共振成像 (MRI) 显示 C4 至 T2 节段的髓内 T2 高信号病变，符合急性纵向广泛横贯性脊髓炎 (LETM)。脑脊液分析为阴性。超声心动图和血液检查提示心肌炎。鼻咽拭子样本的实时聚合酶链反应 (PCR) 检测 SARS-CoV-2 呈阳性。她立即接受大剂量类固醇和免疫球蛋白治疗，临床反应良好。
在 SARS-CoV-2 感染的神经并发症不断发展的文献中，我们增加了迄今为止描述的最年轻患者，该患者存在孤立性 LETM 和伴发心脏受累。我们的病例表明，尽管在婴儿中难以识别，但临床医生应该意识到这种关联。鼓励临床医生考虑积极的一线免疫疗法，最终目的是预防永久性残疾。
