Mild encephalopathy with reversible extensive white matter lesions in a child with acute adenoviral infection and a literature review

Abstract

Background. Mild encephalopathy with a reversible splenial lesion (MERS) is a known clinical-radiological description. However, MERS with extensive lesions (MERS type-2) is rarely associated with adenovirus. There are only three published cases of MERS type-2 associated with adenovirus infection.Case. We present a 10-year-old previously healthy girl who presented with speech difficulty and mild encephalopathy after three days of prodromal illness. The magnetic resonance imaging (MRI) revealed bilateral diffusion restriction in the parietal white matter, splenium and genu of the corpus callosum without mass effect and slight thickening at the splenium of corpus callosum with no contrast enhancement. With empirical and support treatment, her neurological examination was completely normal by the 18th hour. The nasopharyngeal respiratory adenoviral PCR resulted positive. She was discharged with total clinical and radiological resolution on the 10th day of admission. The case was diagnosed with MERS type-2 which is rarely associated with adenoviral infection. Conclusion.This report is the first case of adenovirus related MERS type-2 in a Turkish child. Pediatricians, child neurologists, child infection specialists and radiologists should recognize this condition to ensure appropriate diagnosis.

Acute encephalopathy in a 6-year-old child with concurrent COVID-19 infection: a case report from Saudi Arabia

“…In addition, severe life-threatening complications have been reported, such as encephalopathy, encephalitis, necrotizing hemorrhagic encephalopathy, epileptic seizures, and Guillain-Barre syndrome. Although most of these severe manifestations have been reported in adult patients, few pediatric patients have such complications (Akın et al, 2021, Gaughan et al, 2021, Vraka et al, 2021. Based on a recent published meta-analysis the authors found that in patients with COVID-19-induced encephalopathy, age 70-79 years, low admission lymphocyte counts, and use of corticosteroid and anticoagulants are considered poor prognostic factors (Singh et al, 2022).…”

“…Although the primary target of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the respiratory system, neurological manifestations, including encephalopathy, have been reported in some patients (Akın et al, 2021, Lin et al, 2020, McAbee et al, 2020, Singh et al, 2022, Vraka et al, 2021. The first case of meningoencephalitis associated with SARS-CoV-2 infection was reported in an adult patient in March 2020, with a positive specific SARS-CoV-2 ribonucleic acid (RNA) in the cerebrospinal fluid (CSF) (Poyiadji et al, 2020).…”