ADEM post SARS-CoV-2 infection in a paediatric patient with fisher Evans syndrome

Laura Manzo, Maria; Galati, Cristina; Gallo, Cristina; Santangelo, Giuseppe; Marino, Antonio; Guccione, Fulvio; Raieli, Vincenzo; Pitino, Renata

Background and aims: SARS-CoV-2 is a single-strained RNA virus belonging to Corona viridae's family. In paediatric age the majority of patients are asymptomatic, however several neurological manifestations associated with SARS-CoV-2 infection have been detected in a percentage of cases ranging from 17.3% to 36.4%. Acute Disseminated Encephalomyelitis (ADEM) has been recently included among the potential complications of SARS-CoV-2 infection. The available data regarding paediatric patient show only one case. Methods: Case report: We present a case regarding a six-year-old child suffering from Fisher Evans Syndrome treated with Sirolimus and Thalidomide therapy and affected by SARS-CoV-2 infection. Results: Case report: We present a case regarding a six-year-old patient suffering from Fisher Evans Syndrome who was given Sirolimus and Thalidomide therapy. After ten days since the first positive nasopharyngeal swab for Sars-CoV-2, in which he had no symptoms, he presented an episode of generalized tonic-clonic seizure with spontaneous resolution. The patient underwent MRI which showed the typical picture of Acute Disseminated Encephalomyelitis. His clinical course was favourable, with a good response to cortisone therapy and a progressive improvement of the neuroradiological and electroencephalographic picture. Conclusions: According to our knowledge, this is the second case of an Acute Disseminated Encephalomyelitis following SARS-CoV-2 infection in a paediatric patient, characterized by monosymptomatic onset, in which the immunosuppressive therapy practiced for the Fisher Evans Syndrome has probably contributed to a favourable evolution of ADEM, in contrast to other case described in the literature.