Posterior Reversible Encephalopathy Syndrome in a Child with Sickle Cell Disease and SARS-CoV-2 Infection

Varun Kannan; Sarah Risen

doi:10.1055/s-0041-1742249

Journal of Pediatric Neurology, Table of Contents

Journal of Pediatric Neurology 2022; 20(05): 351-354
DOI: 10.1055/s-0041-1742249

Case Report

Posterior Reversible Encephalopathy Syndrome in a Child with Sickle Cell Disease and SARS-CoV-2 Infection

Varun Kannan

¹Section of Neurology and Developmental Neuroscience, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, United States

,

Sarah Risen

¹Section of Neurology and Developmental Neuroscience, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, United States

› Author Affiliations

Abstract

The full range of neurological manifestations of novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) infection in children remains incompletely characterized. Here, we discussed a 7-year-old male child patient with sickle cell disease (SCD), who presented with acute encephalopathy and nonconvulsive (electrographic only) seizures immediately prior to the onset of severe symptomatic SARS-CoV-2 infection, manifesting as respiratory failure, systemic inflammatory response, and hypertension. Brain imaging confirmed hyperintense lesions consistent with posterior reversible encephalopathy syndrome (PRES). Following aggressive symptomatic management including antiseizure medication, immunomodulatory treatment of SARS-CoV-2 infection, and intensive blood pressure control, he made a full neurological recovery. PRES has been observed in adults with SARS-CoV-2 infection, but there are few published reports of this neurological manifestation in children. Our case demonstrates that PRES should be a consideration in children with SARS-CoV-2 infection presenting with acute neurological decompensation, especially in the setting of preexisting risk factors for cerebrovascular dysregulation such as SCD.

Keywords

sickle cell disease - posterior reversible encephalopathy syndrome - COVID-19 - SARS-CoV-2

Full Text

References

References
1 Harapan BN, Yoo HJ. Neurological symptoms, manifestations, and complications associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19). J Neurol 2021; 268 (09) 3059-3071
2 Aghagoli G, Gallo Marin B, Katchur NJ, Chaves-Sell F, Asaad WF, Murphy SA. Neurological involvement in COVID-19 and potential mechanisms: a review. Neurocrit Care 2021; 34 (03) 1062-1071
3 Parauda SC, Gao V, Gewirtz AN. et al. Posterior reversible encephalopathy syndrome in patients with COVID-19. J Neurol Sci 2020; 416: 117019
4 Lin JE, Asfour A, Sewell TB. et al. Neurological issues in children with COVID-19. Neurosci Lett 2021; 743: 135567
5 Fischer M, Schmutzhard E. Posterior reversible encephalopathy syndrome. J Neurol 2017; 264 (08) 1608-1616
6 Tetsuka S, Ogawa T. Posterior reversible encephalopathy syndrome: a review with emphasis on neuroimaging characteristics. J Neurol Sci 2019; 404: 72-79
7 Hinduja A. Posterior reversible encephalopathy syndrome: clinical features and outcome. Front Neurol 2020; 11: 71
8 Colombo A, Martinelli Boneschi F, Beretta S. et al. Posterior reversible encephalopathy syndrome and COVID-19: a series of 6 cases from Lombardy, Italy. eNeurologicalSci 2020; 22: 100306
9 Anand P, Lau KHV, Chung DY. et al. Posterior reversible encephalopathy syndrome in patients with coronavirus disease 2019: two cases and a review of the literature. J Stroke Cerebrovasc Dis 2020; 29 (11) 105212
10 Franceschi AM, Ahmed O, Giliberto L, Castillo M. Hemorrhagic posterior reversible encephalopathy syndrome as a manifestation of COVID-19 infection. Am J Neuroradiol 2020; 41 (07) 1173-1176
11 Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS. Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive Care Med 2020; 46 (04) 586-590
12 Korkmazer B, Ozogul M, Hikmat E. et al. Posterior reversible encephalopathy syndrome in a pediatric COVID-19 patient. Pediatr Infect Dis J 2021; 40 (06) e240-e242
13 Al Haboob AA. Miller Fischer and posterior reversible encephalopathy syndromes post COVID-19 infection. Neurosciences (Riyadh) 2021; 26 (03) 295-299
14 Farooq S, Testai FD. Neurologic complications of sickle cell disease. Curr Neurol Neurosci Rep 2019; 19 (04) 17
15 Solh Z, Taccone MS, Marin S, Athale U, Breakey VR. Neurological PRESentations in sickle cell patients are not always stroke: a review of posterior reversible encephalopathy syndrome in sickle cell disease. Pediatr Blood Cancer 2016; 63 (06) 983-989
16 Vargas A, Testai FD. Posterior reversible encephalopathy syndrome in adult sickle-cell patients: case series and literature review. J Clin Neurosci 2019; 70: 249-250
17 Raj S, Killinger J, Overby P. Blood transfusion in sickle cell disease leading to posterior reversible encephalopathy syndrome (PRES). J Child Neurol 2013; 28 (10) 1284-1286
18 Santos de Lima F, Klein S, El Ammar F. et al. Rapid development of seizures and PRES in a COVID-19 patient. Epilepsy Behav Rep 2021; 15: 100436