Elsevier

The Journal of Pediatrics

Volume 247, August 2022, Pages 22-28.e2
The Journal of Pediatrics

Original Article
Neuroinflammatory Disease following Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Children

https://doi.org/10.1016/j.jpeds.2022.05.018Get rights and content

Objective

To describe neurologic, radiologic and laboratory features in children with central nervous system (CNS) inflammatory disease complicating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Study design

We focused on CNS inflammatory diseases in children referred from 12 hospitals in the Paris area to Necker-Sick Children Reference Centre.

Results

We identified 19 children who had a history of SARS-CoV-2 infection and manifest a variety of CNS inflammatory diseases: encephalopathy, cerebellar ataxia, acute disseminated encephalomyelitis, neuromyelitis optica spectrum disorder, or optic neuritis. All patients had a history of SARS-CoV-2 exposure, and all tested positive for circulating antibodies against SARS-CoV-2. At the onset of the neurologic disease, SARS-CoV-2 PCR results (nasopharyngeal swabs) were positive in 8 children. Cerebrospinal fluid was abnormal in 58% (11/19) and magnetic resonance imaging was abnormal in 74% (14/19). We identified an autoantibody co-trigger in 4 children (myelin-oligodendrocyte and aquaporin 4 antibodies), representing 21% of the cases. No autoantibody was found in the 6 children whose CNS inflammation was accompanied by a multisystem inflammatory syndrome in children. Overall, 89% of patients (17/19) received anti-inflammatory treatment, primarily high-pulse methylprednisolone. All patients had a complete long-term recovery and, to date, no patient with autoantibodies presented with a relapse.

Conclusions

SARS2-CoV-2 represents a new trigger of postinfectious CNS inflammatory diseases in children.

Abbreviations

ADEM
Acute disseminated encephalomyelitis
AQP4
Aquaporin 4
CNS
Central nervous system
COVID-19
Coronavirus disease 2019
CSF
Cerebrospinal fluid
IL
Interleukin
MIS-C
Multisystem inflammatory syndrome in children
MRI
Magnetic resonance imaging
MOGAD
MOG-associated disorder
MOG
Myelin-oligodendrocyte glycoprotein
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2

Cited by (0)

The authors declare no conflicts of interest.

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