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

Giacomo Brisca; Stefano Sotgiu; Daniela Pirlo; Barbara Tubino; Laura Siri; Benedetta Chianucci; Alessandra Carta; Andrea Rossi; Marisa Mallamaci; Matteo Cataldi; Maria Margherita Mancardi

doi:10.1055/s-0041-1732364

Neuropediatrics, Table of Contents

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

Authors

Giacomo Brisca

¹Department of Surgery and High Intensity of Care, Sub-intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Liguria, Italy
Stefano Sotgiu

²Department of Medical Surgical and Experimental Sciences, Unit of Child Neuropsychiatry, University Hospital of Sassari, Sassari, Sardegna, Italy
Daniela Pirlo

¹Department of Surgery and High Intensity of Care, Sub-intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Liguria, Italy
Barbara Tubino

³Department of Pediatric Sciences, Pediatric Emergency Unit, IRCCS Giannina Gaslini Institute, Genoa, Liguria, Italy
Laura Siri

⁴Unit of Child Neuropsychiatry, Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy
Benedetta Chianucci

⁵Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Liguria, Italy
Alessandra Carta

²Department of Medical Surgical and Experimental Sciences, Unit of Child Neuropsychiatry, University Hospital of Sassari, Sassari, Sardegna, Italy
Andrea Rossi

⁶Department of Medical and Surgical Neuroscience and Rehabilitation, Neuroradiology Unit, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy

⁷Department of Health Sciences (DISSAL), University of Genoa, Genoa, Liguria, Italy
Marisa Mallamaci

¹Department of Surgery and High Intensity of Care, Sub-intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Liguria, Italy
Matteo Cataldi

⁴Unit of Child Neuropsychiatry, Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy
Maria Margherita Mancardi

⁴Unit of Child Neuropsychiatry, Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy

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

Full Text

References

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