Fatal Pediatric COVID-19 Case With Seizures and Fulminant Cerebral Edema

Siddharth Ninan; Peyton Thompson; Timothy Gershon; Natalie Ford; William Mills; Valerie Jewells; Leigh Thorne; Katherine Saunders; Thomas Bouldin; Jason R Smedberg; Melissa B Miller; Eveline Wu; Alyssa Tilly; Jeremy Sites; Daniel Lercher; Katherine Clement; Tracie Walker; Paul Shea; Benny Joyner; Rebecca Smith

doi:10.1177/2329048X211022532

Fatal Pediatric COVID-19 Case With Seizures and Fulminant Cerebral Edema

Child Neurol Open. 2021 Jun 14:8:2329048X211022532. doi: 10.1177/2329048X211022532. eCollection 2021 Jan-Dec.

Authors

Siddharth Ninan¹, Peyton Thompson², Timothy Gershon², Natalie Ford³, William Mills⁴, Valerie Jewells⁵, Leigh Thorne⁶, Katherine Saunders⁶, Thomas Bouldin⁶, Jason R Smedberg⁷, Melissa B Miller^{6

7}, Eveline Wu⁸, Alyssa Tilly⁹, Jeremy Sites¹⁰, Daniel Lercher¹⁰, Katherine Clement¹⁰, Tracie Walker¹⁰, Paul Shea¹⁰, Benny Joyner¹⁰, Rebecca Smith¹⁰

Affiliations

¹ Department of Neurology, University of North Carolina at Chapel Hill, NC, USA.
² Department of Pediatrics, Division of Infectious Diseases, University of North Carolina at Chapel Hill, NC, USA.
³ Department of Pediatrics, University of North Carolina at Chapel Hill, NC, USA.
⁴ Department of Pediatrics, Division of Emergency Medicine, University of North Carolina at Chapel Hill, NC, USA.
⁵ Department of Radiology, University of North Carolina at Chapel Hill, NC, USA.
⁶ Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, NC, USA.
⁷ Clinical Microbiology Laboratory, McLendon Clinical Laboratories, UNC Medical Center, Chapel Hill, NC.
⁸ Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, University of North Carolina at Chapel Hill, NC, USA.
⁹ Departments of Medicine and Pediatrics, Palliative Care Program, University of North Carolina at Chapel Hill, NC, USA.
¹⁰ Department of Pediatrics, Division of Critical Care, University of North Carolina at Chapel Hill, NC, USA.

Abstract

The novel coronavirus, SARS-CoV-2, can present with a wide range of neurological manifestations, in both adult and pediatric populations. We describe here the case of a previously healthy 8-year-old girl who presented with seizures, encephalopathy, and rapidly progressive, diffuse, and ultimately fatal cerebral edema in the setting of acute COVID-19 infection. CSF analysis, microbiological testing, and neuropathology yielded no evidence of infection or acute inflammation within the central nervous system. Acute fulminant cerebral edema (AFCE) is an often fatal pediatric clinical entity consisting of fever, encephalopathy, and new-onset seizures followed by rapid, diffuse, and medically-refractory cerebral edema. AFCE occurs as a rare complication of a variety of common pediatric infections and a CNS pathogen is identified in only a minority of cases, suggesting a para-infectious mechanism of edema. This report suggests that COVID-19 infection can precipitate AFCE, and highlights the need for high suspicion and early recognition thereof.

Keywords: COVID-19; cerebral edema; pediatric; seizures.

Publication types

Case Reports