Posterior Reversible Encephalopathy Syndrome – A Rare Complication of COVID-19 MIS-C

Introduction

As a direct consequence of the worldwide pandemic of the novel 2019 coronavirus disease (COVID-19, SARS-CoV-2 infection), pediatricians started to encounter a novel multisystem condition resulting from an aberrant immune response to SARS-CoV-2 in children and adolescents in early 2020. Due to partial clinical overlap with Kawasaki disease, it was originally assigned as Kawasaki-like disease, and later specified as a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS), or Multisystem inflammatory syndrome in children (MIS-C).

MIS-C is characterized by multi-organ and systemic involvement, with fever and predominantly cardiac, gastrointestinal, skin and mucosal symptoms. Neurological manifestations occur in 15–40% of affected children and adolescents, and may include both the peripheral and central nervous system (Abdel-Mannan O et al., JAMA Neurol 2020; 77: 1–6). Most commonly, these include headaches, meningism, confusion, seizures, unconsciousness, dysarthria, dysphagia, cerebral ataxia, muscle weakness/hyporeflexia, or slow activity on electroencephalography (EEG) (Abdel-Mannan O et al., JAMA Neurol 2020; 77: 1–6). When cerebrospinal fluid is examined, the findings are negative or aseptic (Lad SS et al., Indian J Pediatr 2021; 88: 294–295). We have observed the first documented pediatric patient with posterior reversible encephalopathy syndrome (PRES) as a neurological complication of MIS-C (diagnostic criteria according to World Health Organization definition, https://www.who.int/publications/i/item/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19).

Publication History

Article published online:
03 February 2022