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.