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

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

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.