No abstract

Human parvovirus B19 (HPV B19) infections are usually asymptomatic or benign and self-limiting. In immunocompromised patients and patients with chronic hemolytic anemia, it can lead to transient red cell aplasia. Few reports in the literature have implicated HPV B19 as the possible cause of acute hepatitis and severe aplastic anemia in immunocompetent patients. Here, the authors report a previously healthy 6-year-old girl with acute hepatitis and severe aplastic anemia associated with HPV B19 infection diagnosed by serology (ELISA). Other common causes of these manifestations were ruled out. The clinical manifestations subsequently improved significantly with the use of immunosuppressive therapy confirming an autoimmune mechanism.

Guillain-Barre syndrome (GBS) is a recognized complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report two children with GBS associated with SARS-CoV-2 presented to a tertiary center in Muscat, Oman in 2021: The first patient was a 3-month-old female infant who presented with bradypnea, encephalopathy, and generalized weakness that required mechanical ventilation. Polymerase chain reaction (PCR) testing of the nasopharyngeal swabs (NPS) was positive for SARS-CoV-2. She had axonal variant GBS based on a nerve conduction study, cerebrospinal fluid analysis, and neuroimaging findings. The second patient was a 6-year-old girl with fever, vomiting, and diarrhea followed by ascending weakness who presented with quadriplegia and facial weakness. Subsequently, she developed respiratory muscle weakness and required mechanical ventilation. PCR testing of NPS was negative for SARS-Cov-2, however IgG serology analysis was positive. The clinical course of these two patients was rapidly progressive and both of them required mechanical ventilation. The patient with axonal variant GBS made an incomplete recovery. Keywords: Acute Inflammatory Demyelinating Polyradiculoneuropathy, SARS-CoV-2, Oman

Acute disseminated encephalomyelitis is typically a monophasic multifocal autoimmune demyelinating disease of the central nervous system, which generally follows a febrile infection or a vaccination. It presents with a variety of clinical features reflecting the multifocal nature of the disease. The study was carried out at Sultan Qaboos University Hospital Oman, which is a tertiary care hospital, to see the pattern in this country. A review of inpatients files? records was done with the diagnosis of acute disseminated encephalomyelitis. Inclusion criteria were acute onset, a preceding infection or vaccination, hyperattenuated lesions seen on T2 weighted magnetic resonance imaging, or computerized tomography findings consistent with white matter changes and rapid response to corticosteroids upon therapy. Twenty-three children met the clinical and imaging criteria. Fifteen (65%) were males and eight (35%) were females giving a ratio of 2:1. Their ages ranged from 9 months to 11 years with median age of 5 years. Eleven (48%) patients had a history of an acute respiratory tract infection two to 20 days before presentation. Two (9%) patients had chickenpox, and another two (9%) patients had fever with a rash. One (4%) patient had pneumonia with positive IgM for Mycoplasma pneumonia. None had received a vaccine prior to presentation. Pyramidal signs were seen in the majority of children (83%). Most children had involvement of the subcortical white matter (74%) followed by basal ganglia (24%) and thalamic lesions (24%). Corticosteroids were administered to 21 (91%) children. Eight (35%) of these children had received intravenous immunoglobulin after failure to respond adequately to steroid therapy. Full recovery was seen in 16 (70%) of the patients. The average period of recovery was around 3 weeks. Seven (30%) patients had persistent neurological deficits upon discharge as well as on follow up two years later. The clinical features, outcome and response to treatment were similar to other reported studies. This is the first study to show a clear-cut male predilection of 2:1.