Jyonouchi Harumi, Geng Lee, Rossignol Daniel A, Frye Richard E
Saint Peter's University Hospital (SPUH), New Brunswick, NJ 08901, USA.
Rossignol Medical Center, Aliso Viejo, CA 92656, USA.
J Pers Med. 2022 Nov 2;12(11):1815. doi: 10.3390/jpm12111815.
COVID-19 causes not only severe respiratory symptoms, but also long-term sequelae, even if the acute-phase symptoms are minor. Neurological and neuropsychiatric symptoms are emerging as major long-term sequalae. In patients with pre-existing behavioral symptoms, such as individuals with autism spectrum disorders (ASD), the emergence of neuropsychiatric symptoms due to long COVID can be difficult to diagnose and manage. Herein, we present three ASD cases who presented with markedly worsening neuropsychiatric symptoms following COVID-19 exposure and subsequent difficulty in managing the post-COVID neuropsychiatric symptoms. Case 1 contracted SARS-CoV-2 during the early stages of the pandemic and treatment targeting COVID-19-induced immune activation was delayed. Case 2 was asymptomatic in the acute stage of a confirmed COVID-19 exposure, but still developed significant neuropsychiatric symptoms. Case 3 demonstrated a difficult course, partly due to pre-existing immune dysregulation and prior use of multiple immunomodulating agents. In cases 1 and 3 for whom serial blood samples were obtained, notable changes in the production of inflammatory and counter-regulatory cytokines by peripheral blood monocytes were observed. The presented cases illustrate the profound effects of COVID-19 on neuropsychiatric symptoms in ASD subjects and the difficulty of managing long-COVID symptoms.
新冠病毒病不仅会引发严重的呼吸道症状，还会导致长期后遗症，即便急性期症状轻微。神经和神经精神症状正成为主要的长期后遗症。在患有如自闭症谱系障碍（ASD）等既往行为症状的患者中，长期新冠导致的神经精神症状可能难以诊断和处理。在此，我们报告三例ASD病例，这些病例在接触新冠病毒后神经精神症状明显恶化，随后在处理新冠后神经精神症状时遇到困难。病例1在疫情早期感染了严重急性呼吸综合征冠状病毒2（SARS-CoV-2），针对新冠病毒诱导的免疫激活的治疗被推迟。病例2在确诊接触新冠病毒的急性期无症状，但仍出现了明显的神经精神症状。病例3病程艰难，部分原因是既往存在免疫失调以及先前使用过多种免疫调节药物。在获取了系列血样的病例1和病例3中，观察到外周血单核细胞产生的炎性和反调节细胞因子有显著变化。所报告的病例说明了新冠病毒病对ASD患者神经精神症状的深远影响以及处理长期新冠症状的困难。
