Coronavirus disease 2019-associated acute necrotizing encephalopathy in a 9-year-old boy
Coronavirus disease 2019 (COVID-19) is associated with a variety of neurologic manifestations. Acute necrotizing encephalopathy (ANE) is a rare, life-threatening complication characterized by rapid deterioration of neurologic status following viral infection, such as influenza or human herpesvirus 6...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Korean Society of Pediatric Emergency Medicine
2023-10-01
|
| Series: | Pediatric Emergency Medicine Journal |
| Subjects: | |
| Online Access: | http://pemj.org/upload/pdf/pemj-2023-00724.pdf |
| _version_ | 1797660793262571520 |
|---|---|
| author | Ock-Bin Im Min-Jee Kim Mi-Sun Yum Won Kyoung Jhang |
| author_facet | Ock-Bin Im Min-Jee Kim Mi-Sun Yum Won Kyoung Jhang |
| author_sort | Ock-Bin Im |
| collection | DOAJ |
| description | Coronavirus disease 2019 (COVID-19) is associated with a variety of neurologic manifestations. Acute necrotizing encephalopathy (ANE) is a rare, life-threatening complication characterized by rapid deterioration of neurologic status following viral infection, such as influenza or human herpesvirus 6. Since the COVID-19 pandemic, a rise in ANE cases associated with the infectious disease has been reported in adult patients. We present a case of COVID-19-associated ANE in a 9-year-old boy. The patient experienced 3 days of fever and mild respiratory symptoms, followed by lethargy. Magnetic resonance imaging on day 4 showed hyperintensity in the bilateral thalami, midbrain, pons, hypothalamus, and cerebellum, along with some areas of hemorrhage. From the imaging findings, ANE was strongly suspected, leading to the initiation treatment involving a 5-day course of remdesivir and multiple immunomodulator therapies, including high-dose corticosteroids, intravenous immunoglobulin, tocilizumab, and 10 cycles of therapeutic plasma exchange. Subsequently, the patient gradually improved, experiencing only minor neurological sequelae and showing favorable radiologic improvement. In COVID-19-infected patients presenting neurologic symptoms, it is crucial to promptly suspect and investigate unexplained encephalopathy using neuroimaging. Early administration of immunomodulator therapy is vital for the diagnosis and optimizing clinical outcomes. |
| first_indexed | 2024-03-11T18:35:59Z |
| format | Article |
| id | doaj.art-89d0bb66166c48bf92619dd1be6453f0 |
| institution | Directory Open Access Journal |
| issn | 2383-4897 2508-5506 |
| language | English |
| last_indexed | 2024-03-11T18:35:59Z |
| publishDate | 2023-10-01 |
| publisher | Korean Society of Pediatric Emergency Medicine |
| record_format | Article |
| series | Pediatric Emergency Medicine Journal |
| spelling | doaj.art-89d0bb66166c48bf92619dd1be6453f02023-10-13T01:05:07ZengKorean Society of Pediatric Emergency MedicinePediatric Emergency Medicine Journal2383-48972508-55062023-10-0110414214810.22470/pemj.2023.00724181Coronavirus disease 2019-associated acute necrotizing encephalopathy in a 9-year-old boyOck-Bin Im0Min-Jee Kim1Mi-Sun Yum2Won Kyoung Jhang3Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Republic of KoreaDepartment of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Republic of KoreaDepartment of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Republic of KoreaDivision of Pediatric Critical Care Medicine, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Republic of KoreaCoronavirus disease 2019 (COVID-19) is associated with a variety of neurologic manifestations. Acute necrotizing encephalopathy (ANE) is a rare, life-threatening complication characterized by rapid deterioration of neurologic status following viral infection, such as influenza or human herpesvirus 6. Since the COVID-19 pandemic, a rise in ANE cases associated with the infectious disease has been reported in adult patients. We present a case of COVID-19-associated ANE in a 9-year-old boy. The patient experienced 3 days of fever and mild respiratory symptoms, followed by lethargy. Magnetic resonance imaging on day 4 showed hyperintensity in the bilateral thalami, midbrain, pons, hypothalamus, and cerebellum, along with some areas of hemorrhage. From the imaging findings, ANE was strongly suspected, leading to the initiation treatment involving a 5-day course of remdesivir and multiple immunomodulator therapies, including high-dose corticosteroids, intravenous immunoglobulin, tocilizumab, and 10 cycles of therapeutic plasma exchange. Subsequently, the patient gradually improved, experiencing only minor neurological sequelae and showing favorable radiologic improvement. In COVID-19-infected patients presenting neurologic symptoms, it is crucial to promptly suspect and investigate unexplained encephalopathy using neuroimaging. Early administration of immunomodulator therapy is vital for the diagnosis and optimizing clinical outcomes.http://pemj.org/upload/pdf/pemj-2023-00724.pdfbrain diseasescovid-19immunologic factorsplasma exchangesars-cov-2 |
| spellingShingle | Ock-Bin Im Min-Jee Kim Mi-Sun Yum Won Kyoung Jhang Coronavirus disease 2019-associated acute necrotizing encephalopathy in a 9-year-old boy Pediatric Emergency Medicine Journal brain diseases covid-19 immunologic factors plasma exchange sars-cov-2 |
| title | Coronavirus disease 2019-associated acute necrotizing encephalopathy in a 9-year-old boy |
| title_full | Coronavirus disease 2019-associated acute necrotizing encephalopathy in a 9-year-old boy |
| title_fullStr | Coronavirus disease 2019-associated acute necrotizing encephalopathy in a 9-year-old boy |
| title_full_unstemmed | Coronavirus disease 2019-associated acute necrotizing encephalopathy in a 9-year-old boy |
| title_short | Coronavirus disease 2019-associated acute necrotizing encephalopathy in a 9-year-old boy |
| title_sort | coronavirus disease 2019 associated acute necrotizing encephalopathy in a 9 year old boy |
| topic | brain diseases covid-19 immunologic factors plasma exchange sars-cov-2 |
| url | http://pemj.org/upload/pdf/pemj-2023-00724.pdf |
| work_keys_str_mv | AT ockbinim coronavirusdisease2019associatedacutenecrotizingencephalopathyina9yearoldboy AT minjeekim coronavirusdisease2019associatedacutenecrotizingencephalopathyina9yearoldboy AT misunyum coronavirusdisease2019associatedacutenecrotizingencephalopathyina9yearoldboy AT wonkyoungjhang coronavirusdisease2019associatedacutenecrotizingencephalopathyina9yearoldboy |