Case report: Distinct neurologic manifestation and cytokine profile of a child with COVID-19-associated acute fulminant encephalitis

Yu-Ming Chang; Cheng-Han Chen; Jieh-Neng Wang; Chao-Min Cheng; Yi-Fang Tu; Ching-Fen Shen

doi:10.3389/fmed.2023.1209656

Case report: Distinct neurologic manifestation and cytokine profile of a child with COVID-19-associated acute fulminant encephalitis

Front Med (Lausanne). 2023 Jun 13:10:1209656. doi: 10.3389/fmed.2023.1209656. eCollection 2023.

Authors

Yu-Ming Chang¹, Cheng-Han Chen^{2

3

4}, Jieh-Neng Wang¹, Chao-Min Cheng², Yi-Fang Tu^#^{1

5}, Ching-Fen Shen^#^{1

5}

Affiliations

¹ Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
² Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan.
³ Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
⁴ School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁵ Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

^# Contributed equally.

Abstract

The neurologic manifestations of coronavirus disease 2019 (COVID-19) may range from mild symptoms such as headache or confusion to profound encephalopathy with variable outcomes and sequelae. Here, we reported a case of fatal COVID-19-associated encephalitis with acute fulminant cerebral edema, presenting first with visual hallucination and then a rapid progression into comatose status in a few hours. Serial brain computed tomography depicted cerebral edematous changes from bilateral ventral temporal lobe to the whole brain leading to brain herniation. Multiple cytokines in serum and cerebrospinal fluid (CSF) were increased, with a more prominent rise in the CSF. Therefore, we postulated a hypothesis regarding the mechanism of this fulminant encephalitis that the SARS-CoV-2 virus attacked ventral temporal lobes initially, triggered a severe cytokine storm, and then led to subsequent disruption of the blood-brain barrier, diffuse brain edema, and brain herniation. The trend of cytokine profiles over time may aid in diagnosing and evaluating the severity and prognosis of COVID-19-associated encephalitis.

Keywords: COVID-19; SARS-CoV-2; acute fulminant cerebral edema; cerebral edema; cytokine; encephalitis.

Publication types

Case Reports

Grants and funding

This work was supported by grants from the Clinical Medical Research Center, National Cheng Kung University Hospital, Taiwan (NCKUH-11202012) and Ministry of Science and Technology, Taiwan (110-2923-B-006-001-MY4).