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Neuropediatrics 2022; 53(01): 061-064
DOI: 10.1055/s-0041-1732364
Short Communication

Longitudinally Extensive Transverse Myelitis (LETM) and Myopericarditis in a 7-Month-Old Child with SARs-CoV-2 Infection

Giacomo Brisca 
1   Department of Surgery and High Intensity of Care, Sub-intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Liguria, Italy
,
Stefano Sotgiu
2   Department of Medical Surgical and Experimental Sciences, Unit of Child Neuropsychiatry, University Hospital of Sassari, Sassari, Sardegna, Italy
,
Daniela Pirlo
1   Department of Surgery and High Intensity of Care, Sub-intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Liguria, Italy
,
Barbara Tubino
3   Department of Pediatric Sciences, Pediatric Emergency Unit, IRCCS Giannina Gaslini Institute, Genoa, Liguria, Italy
,
Laura Siri
4   Unit of Child Neuropsychiatry, Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy
,
Benedetta Chianucci
5   Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Liguria, Italy
,
Alessandra Carta
2   Department of Medical Surgical and Experimental Sciences, Unit of Child Neuropsychiatry, University Hospital of Sassari, Sassari, Sardegna, Italy
,
Andrea Rossi
6   Department of Medical and Surgical Neuroscience and Rehabilitation, Neuroradiology Unit, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy
7   Department of Health Sciences (DISSAL), University of Genoa, Genoa, Liguria, Italy
,
Marisa Mallamaci
1   Department of Surgery and High Intensity of Care, Sub-intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Liguria, Italy
,
Matteo Cataldi
4   Unit of Child Neuropsychiatry, Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy
,
Maria Margherita Mancardi
4   Unit of Child Neuropsychiatry, Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy
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Abstract

Introduction 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.

Methods 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.

Results 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.

Conclusion 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.

Keywords

longitudinally extensive transverse myelitis - demyelination - COVID-19 - myopericarditis


Publikationsverlauf

Eingereicht: 15. April 2021

Angenommen: 10. Juni 2021

Artikel online veröffentlicht:
29. Juli 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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