Pediatric multiple sclerosis post covid: a case report

Case presentation: Female adolescent, 15 years old, complains that for 6 months she has felt generalized muscle weakness and that has increased in recent days associated with changes in muscle sensitivity in left dimidium, evolving in 1 week to the right and ~15 days after, culminates with bilaterally lower limb plegia. She denies fever and use of medication for continuous use. Her relevant personal history is: tested positive for SARS-CoV-2 6 months before neurological symptoms. In the neurological evaluation, the muscular strength of the lower limbs was symmetrical of IV and V in the upper limbs, sensory level close to the thoracoabdominal transition (T9-T10) (with impairment of tactile, pain, vibratory and proprioceptive sensitivity), abolished Aquileus reflex, flaccid paraparesis of lower limbs with exaltation of patellar reflexes. Patient, in the absence of infectious signs, was hospitalized and conducted to methylprednisolone pulsotherapy associated with Omeprazole and Albendazole. The patient was initially classified as Clinically Isolated Syndrome (CIS) and the diagnosis of the disease was later closed with the result of the liquoric puncture with oligoclonal bands present and thus, the transition was made to the therapy with Glathyromer Acetate, Gabapentin and Vitamin D.

Discussion: Although the pathophysiological mechanisms of SARS-CoV-2 are not completely elucidated, its neuroinvasive capacity is already known for the emergence of post-infectious neurological complications. In the case described, the patient had acute neurological symptoms of paresis, plegia and loss of muscle sensitivity ~6 months after infection with COVID-19. As it is a viral infection with complications in multiple systems and, among them, the central nervous system by neurotropism, it is likely that COVID-19 has played a trigger role for the development of MS. The subsequent liquoric puncture with the presence of oligoclonal bands made it possible to confirm the DM picture by applying the diagnostic criteria of McDonald 2017.

Final comments: Although there is little scientific evidence available on this subject, we believe that there is a late stage of multiple sclerosis, probably associated with SARS-CoV-2 infection. Thus, we expect that the exposure and discussion of this clinical case might collaborate - as a form of evidence-, with the knowledge at the disposal of this pathology in pediatrics.

 

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Artikel online veröffentlicht:
18. September 2023