AUTHOR=Cautilli Francesca , Feleppa Mariavittoria , Valeriani Massimiliano , Papetti Laura , Monte Gabriele , Midulla Fabio , Spalice Alberto 

TITLE=Case report: A case of acute disseminated encephalomyelitis after SARS-CoV-2 infection in pediatric patients

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1099458

DOI=10.3389/fneur.2023.1099458

ISSN=1664-2295

ABSTRACT=From the beginning of the recent pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), it was evident the multi-systemic involvement of the coronavirus disease 2019 (COVID-19). Emerging evidences revealed that, together with others, neurological manifestation, typical and not, are also associated with COVID-19 infection. In the first 2 years children accounted for a few percent of cases, but, with Omicron variant, the number of cases in pediatric population is increased. It is described that around 5 % suffered severe neurological complications, such as seizure, coma, encephalitis, demyelinating disorders, and aseptic meningitis. Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system. Typically it is present in childhood and occurs 1 or 2 weeks after infections or vaccinations.
We present a case of a 12-years-old  boy who developed ADEM 10 days after asymptomatic SARS-CoV-2 infection. The neurological symptoms began with headache, fever, irritability, paraplegia, loss of sensitivity from T1 level. The diagnosis of ADEM was confirmed by the typical signs found in brain MRI while the spinal cord MRI showed signs of transverse myelitis. CSF testing excluded infections and did not reveal oligoclonal bands autoantibodies (anti-MOG negative and anti-AQP4). High-dose steroids (30 mg/kg/die) and IVIG (2 gr/kg) were provided to the patient, without any clinical improvement. The patient received a cycle of plasma exchange therapy, followed by Rituximab infusion, with partial improvement. The MRI performed after three months demonstrated   radiological improvement, in accordance with ADEM diagnosis. 
This clinical case confirms that SARS-CoV-2 infections is increasingly implicated in  severe neurological consequences both in adult and in pediatric patients. While the most frequent complication reported in children are headache, altered mental status, and encephalopathy, around 5 % suffered severe neurological complications causing  important long life sequelae.  All the physicians should be aware of these data in order to detect as soon as possible neurological signs of severe (or not) complications that require a specific follow up and treatment.