Chien Tzu-Chien, Chien Mu-Ming, Liu Tsai-Ling, Chang Hsi, Tsai Min-Lan, Tseng Sung-Hui, Ho Wan-Ling, Su Yi-Yu, Lin Hsiu-Chen, Lu Jen-Her, Chang Chia-Yau, Hsieh Kevin Li-Chun, Wong Tai-Tong, Miser James S, Liu Yen-Lin
Department of Pediatrics, Taipei Medical University Hospital, Taipei 110, Taiwan.
Pediatric Brain Tumor Program, Taipei Cancer Center, Taipei Medical University, Taipei 110, Taiwan.
Children (Basel). 2022 Aug 17;9(8):1238. doi: 10.3390/children9081238.
There is an increasing number of reported cases with neurological manifestations of COVID-19 in children. Symptoms include headache, general malaise, ageusia, seizure and alterations in consciousness. The differential diagnosis includes several potentially lethal conditions including encephalopathy, encephalitis, intracranial hemorrhage, thrombosis and adrenal crisis. We report the case of a 17-year-old boy with a positive antigen test of COVID-19 who presented with fever for one day, altered mental status and seizure, subsequently diagnosed with adrenal insufficiency. He had a history of panhypopituitarism secondary to a suprasellar craniopharyngioma treated with surgical resection; he was treated with regular hormone replacement therapy. After prompt administration of intravenous hydrocortisone, his mental status returned to normal within four hours. He recovered without neurologic complications. Adrenal insufficiency can present with neurological manifestations mimicking COVID-19 encephalopathy. Prompt recognition and treatment of adrenal insufficiency, especially in patients with brain tumors, Addison's disease or those recently treated with corticosteroids, can rapidly improve the clinical condition and prevent long-term consequences.
儿童COVID-19出现神经症状的报告病例越来越多。症状包括头痛、全身不适、味觉丧失、癫痫发作和意识改变。鉴别诊断包括几种潜在的致命疾病，如脑病、脑炎、颅内出血、血栓形成和肾上腺危象。我们报告一例17岁男孩，COVID-19抗原检测呈阳性，出现发热1天、精神状态改变和癫痫发作，随后被诊断为肾上腺功能不全。他有鞍上颅咽管瘤手术切除后继发的全垂体功能减退病史，接受常规激素替代治疗。静脉注射氢化可的松后，他的精神状态在4小时内恢复正常。他康复且无神经并发症。肾上腺功能不全可表现出类似COVID-19脑病的神经症状。及时识别和治疗肾上腺功能不全，尤其是脑肿瘤患者、艾迪生病患者或近期接受过皮质类固醇治疗的患者，可迅速改善临床状况并预防长期后果。
