Abstract:
Background: Multisystem inflammatory syndrome in children (MIS-C) is observed with severe signs of COVID-19. Some reports indicated the effect of MIS-C on the neurological manifestations of the children.
Case presentation: A 13-year-old Iranian boy was transferred to the emergency department of Shiraz, Iran in May 2022 from a deprived area with fever, generalized skin rashes, palmar erythema, vomiting, vomit, and diarrhea. Severe conjunctivitis, photophobia, headache, and ataxia were also observed on the day of admission. His neurological manifestations were improved by the treatments including high-dose methylprednisolone and intravenous immunoglobulin (IVIG). He was discharged nine days after the admission.
Conclusions: Because of the low presence of ataxia and papilledema in MIS-C after COVID-19, as far as we know, we presented the first study of this presentation.
Keywords: Multisystem inflammatory syndrome; COVID-19; Ataxia; Papilledema
Background:
Multisystem inflammatory syndrome in children (MIS-C) is observed in children with severe signs of COVID-19. MIS-C is known as a multisystem inflammation in individuals below 21 years with the presentation of organ involvement (at least two organs out of 4 including heart, skin, eye, and gastrointestinal organs), laboratory signs of inflammation, fever, and being in contact with a COVID-19 patient or SARS-COV2 confirmed by laboratory tests (1). The incidence of neurologic symptoms like headache, meningitis, encephalopathy, photophobia, fever, and rarely papilledema and ataxia was 13–21% in MIS-C patients (2). Ataxia contains an absence of coordination of muscle movements including eye movements abnormality, gait abnormality, and speech changes. Some types of ataxia like acute post-infectious cerebellar ataxia can take place among children after bacterial or viral infections (3). Papilledema is known as swelling of optic nerves as a result of high intracranial pressure, which leads to nerve damage and vision loss. It may be a hallmark of pseudotumor cerebri. Pseudotumor cerebri is known for the elevation of lumbar puncture (LP) opening pressure, normal Magnetic Resonance Imaging (MRI) findings, and abducens palsy but other normal neurological exams. High intracranial pressure may be induced by inflammatory disorders like Kawasaki disease and systemic lupus erythematosus (4). As far as we know, we reported the first case of MIS-C presented by papilledema and ataxia, simultaneously.
Case presentation:
A 13-year-old Iranian boy without any underling disease was transferred to the emergency department of Shiraz, Iran in May 2022 from a deprived area with the symptoms of fever since 5 days ago, generalized skin rashes, palmar erythema, nausea, vomiting, and diarrhea. Severe conjunctivitis, photophobia, headache, and ataxia were also observed on the day of admission. He was moved to the pediatric intensive care unit (PICU) for additional management. His vital signs were blood pressure of 114/57 mmHg, pulse rate of 111 PR/min, respiratory rate of 20 RR/min, the body temperature of 37.8 centigrade, and oxygen saturation of 96% without oxygen supplements at rest in the room. Polymerase Chain Reaction (PCR) was negative for COVID-19 but the serology IgG and IgM test was positive. No signs of respiratory disorder were observed. In the physical examination, conjunctivitis, loss of vision, and strawberry tongue were seen. The sounds of the heart and lungs were bilaterally clear.
Inflammatory markers were elevated in the first days of admission. Full laboratory results were summarized in Table 1.