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Case Report
Medwave 2020;20(7):e7985 doi: 10.5867/medwave.2020.07.7985
Encephalitis associated with COVID-19 in a 13-year-old girl: A case report
Nadin Melina Conto-Palomino, María Luz Cabrera-Bueno, Kenneth Grenis Vargas-Ponce , Evelina Andrea Rondón-Abuhadba , Noé Atamari-Anahui
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Key Words: encephalitis, coronavirus infections, COVID-19, child, pediatrics, perú

Abstract

There are limited reports of neurological symptoms in the pediatric population with COVID-19. We report a 13-year-old girl with three days of illness characterized by headache, non-explosive vomiting, fever, and sudden-onset sensory disorder associated with difficulty in standing and hemiparesis in limbs without evidence of meningeal signs. Brain tomography revealed diffuse brain edema, and the cerebrospinal fluid study was consistent with a viral infection. COVID-19 was diagnosed based on serology. The patient had an untoward clinical course despite treatment with hydroxychloroquine, azithromycin, and corticosteroids, dying on the third day of hospitalization. Encephalitis in a patient with COVID-19 is not frequently reported in the pediatric population. It should be considered in the differential diagnosis in patients who arrives at the emergency with a sensory disorder or neurological symptomatology in the context of the COVID-19 pandemic.


 

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Existen limitados reportes de síntomas neurológicos en la población pediátrica con COVID-19. Reportamos el caso de una niña de 13 años con tres días de enfermedad caracterizada por cefalea, vómitos no explosivos, fiebre y trastorno del sensorio de inicio brusco asociado a dificultad para la bipedestación y hemiparesia en extremidades, sin evidencia de signos meníngeos. La tomografía cerebral reveló edema cerebral difuso y el estudio de líquido cefalorraquídeo era concordante con una infección viral. El diagnóstico de COVID-19 fue mediante pruebas serológicas. La paciente tuvo una evolución clínica desfavorable a pesar del tratamiento con hidroxicloroquina, azitromicina y corticoides, falleciendo al tercer día de hospitalización. La encefalitis en un paciente con COVID-19 es una asociación poco descrita en la población pediátrica. Esta infección debe ser considerado como diagnóstico diferencial en los pacientes que llegan a la emergencia con trastorno de sensorio o sintomatología neurológica en el contexto de la actual pandemia.

Authors: Nadin Melina Conto-Palomino[1], María Luz Cabrera-Bueno[1], Kenneth Grenis Vargas-Ponce [2], Evelina Andrea Rondón-Abuhadba [3], Noé Atamari-Anahui [4]

Affiliation:
[1] Servicio de Pediatría, Hospital Nacional Arzobispo Loayza, Lima, Perú
[2] Servicio de Neumología, Hospital Nacional Dos de Mayo, Lima, Perú
[3] Escuela Profesional de Medicina Humana, Facultad de Ciencias de la Salud, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Perú
[4] Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Perú

E-mail: noe.atamari@gmail.com

Author address:
[1] Avenida La Fontana 550, La Molina
Lima, Perú

Citation: Conto-Palomino NM, Cabrera-Bueno ML, Vargas-Ponce KG, Rondón-Abuhadba EA, Atamari-Anahui N. Encephalitis associated with COVID-19 in a 13-year-old girl: A case report. Medwave 2020;20(7):e7985 doi: 10.5867/medwave.2020.07.7985

Submission date: 30/4/2020

Acceptance date: 30/6/2020

Publication date: 3/8/2020

Origin: Not commissioned

Type of review: Externally peer-reviewed by five reviewers, double-blind

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  12. Li Y, Li H, Fan R, Wen B, Zhang J, Cao X, et al. Coronavirus Infections in the Central Nervous System and Respiratory Tract Show Distinct Features in Hospitalized Children. Intervirology. 2016;59(3):163-169. | CrossRef | PubMed |
  13. Henry BM, Lippi G, Plebani M. Laboratory abnormalities in children with novel coronavirus disease 2019. Clin Chem Lab Med. 2020 Jun 25;58(7):1135-1138. | CrossRef | PubMed |
  14. Moriguchi T, Harii N, Goto J, Harada D, Sugawara H, Takamino J, et al. A first of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis. 2020 May;94:55-58. | CrossRef | PubMed |
  15. Ye M, Ren Y, Lv T. Encephalitis as a clinical manifestation of COVID-19. Brain Behav Immun. 2020 Apr 10:S0889-1591(20)30465-7. | CrossRef | PubMed |
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  18. Li YC, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol. 2020 Jun;92(6):552-555. | CrossRef | PubMed |
  19. Clerkin KJ, Fried JA, Raikhelkar J, Sayer G, Griffin JM, Masoumi A, et al. COVID-19 and Cardiovascular Disease. Circulation. 2020 May 19;141(20):1648-1655. | CrossRef | PubMed |
Sánchez-Tauma PJ, Atamari-Anahui N, Valera-Moreno C. Enfermedad por Coronavirus 2019, COVID-19: Aspectos a considerar en niños. Revista del Cuerpo Médico del HNAAA. 2020;13(1):88-94. [On line] | Link |

Johns Hopkins University. Coronavirus COVID-19 Global Cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU). Johns Hopkins Coronavirus Resource Center. 2020. [On line] | Link |

Ministerio de Salud del Perú. Sala Situacional COVID-19 Perú. 2020. [On line] | Link |

Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, et al. SARS-CoV-2 Infection in Children. N Engl J Med. 2020 Apr 23;382(17):1663-1665. | CrossRef | PubMed |

Wilson MP, Jack AS. Coronavirus disease 2019 (COVID-19) in neurology and neurosurgery: A scoping review of the early literature. Clin Neurol Neurosurg.2020 Jun;193:105866. | CrossRef | PubMed |

Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H, Singh IP, et al. Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young. N Engl J Med. 2020 May 14;382(20):e60. | CrossRef | PubMed |

Mao L, Wang M, Chen S, He Q, Chang J, Hong C, et al. Neurological Manifestations of Hospitalized Patients with COVID-19 in Wuhan, China: a retrospective case series study. medRxiv. 2020. [On line] | Link |

McAbee GN, Brosgol Y, Pavlakis S, Agha R, Gaffoor M. Encephalitis Associated with COVID-19 Infection in an 11-Year-Old Child. Pediatr Neurol. 2020 Aug;109:94. | CrossRef | PubMed |

CDC COVID-19 Response Team. Coronavirus Disease 2019 in Children - United States, February 12-April 2, 2020. MMWR Morb Mortal Wkly Rep. 2020 Apr 10;69(14):422-426. | CrossRef | PubMed |

Matías-Guiu J, Gomez-Pinedo U, Montero-Escribano P, Gomez-Iglesias P, Porta- Etessam J, Matias-Guiu JA. Should we expect neurological symptoms in the SARS- CoV-2 epidemic? Neurologia. 2020 Apr;35(3):170-175. English, Spanish. | CrossRef | PubMed |

Steardo L, Steardo L Jr, Zorec R, Verkhratsky A. Neuroinfection may contribute to pathophysiology and clinical manifestations of COVID-19. Acta Physiol (Oxf). 2020 Jul;229(3):e13473. | CrossRef | PubMed |

Li Y, Li H, Fan R, Wen B, Zhang J, Cao X, et al. Coronavirus Infections in the Central Nervous System and Respiratory Tract Show Distinct Features in Hospitalized Children. Intervirology. 2016;59(3):163-169. | CrossRef | PubMed |

Henry BM, Lippi G, Plebani M. Laboratory abnormalities in children with novel coronavirus disease 2019. Clin Chem Lab Med. 2020 Jun 25;58(7):1135-1138. | CrossRef | PubMed |

Moriguchi T, Harii N, Goto J, Harada D, Sugawara H, Takamino J, et al. A first of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis. 2020 May;94:55-58. | CrossRef | PubMed |

Ye M, Ren Y, Lv T. Encephalitis as a clinical manifestation of COVID-19. Brain Behav Immun. 2020 Apr 10:S0889-1591(20)30465-7. | CrossRef | PubMed |

Ministerio de Salud del Perú. Prevención, diagnóstico y tratamiento de personas afectadas por COVID-19 en el Perú.2020.[On line] | Link |

Ministerio de Salud del Perú. Modificación del Documento Técnico: Prevención Diagnóstico y Tratamiento de personas afectadas por COVID-19 en el Perú. 2020. [On line] | Link |

Li YC, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol. 2020 Jun;92(6):552-555. | CrossRef | PubMed |

Clerkin KJ, Fried JA, Raikhelkar J, Sayer G, Griffin JM, Masoumi A, et al. COVID-19 and Cardiovascular Disease. Circulation. 2020 May 19;141(20):1648-1655. | CrossRef | PubMed |