N-Methyl-d-Aspartate Receptor Encephalitis Associated With COVID-19 Infection in a Toddler

Burr, Tyler; Barton, Christopher; Doll, Elizabeth; Lakhotia, Arpita; Sweeney, Michael

doi:10.1016/j.pediatrneurol.2020.10.002

Cited by 86 publications

(81 citation statements)

References 10 publications

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“…Monti et al [ 6 ] reported a 50-year-old patient with status epilepticus, anti-NMDAR antibody, and COVID-19 rtPCR positivity but no respiratory or systemic symptoms; Panariello et al [ 4 ] described a 23-year-old boy with acute psychosis due to anti-NMDAR encephalitis, also with no respiratory system involvement. Younger patients with anti-NMDAR encephalitis and COVID-19 positivity were reported by Burr et al [ 5 ] and Moideen et al [ 7 ] in 23 months and 17-year-old patients, respectively, the latter with acute psychosis. Our patient, unlike those in other reports, manifested with acute ataxia, only to become encephalopathic over days.…”

Section: Discussionmentioning

confidence: 77%

Pediatric anti-NMDA receptor encephalitis associated with COVID-19

et al. 2021

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Anti-N-methyl-D-aspartate receptor encephalitis is a clinical condition characterized by acute behavioral and mood changes, abnormal movements, autonomic instability, seizures, and encephalopathy. We describe a 7-year-old boy diagnosed with autoimmune encephalitis due to NMDAR antibody in association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019) (COVID-19), without pulmonary involvement or fever. The patient presented with acute ataxia, rapidly developed encephalopathy, and autoimmune encephalitis was suspected. Steroid treatment was withheld because of lymphopenia and intravenous immunoglobulin was started. The absence of clinical response prompted plasmapheresis and, when lymphocyte counts improved, pulse steroid treatment was applied. The latter was followed by significant improvement and the patient was discharged in a conscious and ambulatory state. Autoimmune encephalitis should be considered in the presence of neurological symptoms accompanying SARS-CoV-2 infection and steroid treatment should be preferred unless limited by contraindications.

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Section: Discussionmentioning

confidence: 77%

Pediatric anti-NMDA receptor encephalitis associated with COVID-19

et al. 2021

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“…Increased expression of NMDARs occurs in a variety of cancers such as neuroblastoma, breast, small-cell lung, and ovarian cancer(39). Anti-NMDAR encephalitis, characterized by abnormal neurological and behavioral symptoms, has been reported in both COVID-19 and HSV(40). Notably, HSV can lead to an increased cervical cancer risk(41, 42).…”

Section: Resultsmentioning

confidence: 99%

MOATAI-VIR - an AI algorithm that predicts severe adverse events and molecular features for COVID-19’s complications

Astore

Zhou

Jacob

et al. 2021

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Following SARS-CoV-2 infection, some COVID-19 patients experience severe adverse events caused by pathogenic host responses. To treat these complications, their underlying etiology must be identified. Thus, a novel AI-based methodology, MOATAI-VIR, which predicts disease-protein-pathway relationships for 22 clinical manifestations attributed to COVID-19 was developed. SARS-CoV-2 interacting human proteins and GWAS identified respiratory failure associated risk genes provide the input from which the mode-of-action (MOA) proteins/pathways of the resulting disease comorbidities are predicted. These comorbidities are then mapped to their clinical manifestations. Three uncharacterized manifestation categories are found: neoplasms, mental and behavioral disorders, and congenital malformations, deformations, and chromosomal abnormalities. The prevalence of neoplasms suggests a possible association between COVID-19 and cancer, whether by shared molecular mechanisms between oncogenesis and viral replication, or perhaps, SARS-CoV-2 is an oncovirus. To assess the molecular basis of each manifestation, the proteins shared across each group of comorbidities were prioritized and subject to global pathway analysis. From these most frequent pathways, the molecular features associated with hallmark COVID-19 phenotypes, such as loss of sense of smell/taste, unusual neurological symptoms, cytokine storm, and blood clots were explored. Results of MOATAI-VIR are available for academic users at: http://pwp.gatech.edu/cssb/MOATAI-VIR/.

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“…We read with great interest the article by Burr et al on NMDA- receptor encephalitis associated with COVID-19 infection. 1 Although Anti-NMDAR encephalitis has been associated with COVID-19 in adults, this is the first report in a child. 2 With initial evidence for COVID-19 in children suggesting an asymptomatic or mild course in most, the identification and management of novel clinical presentations become even more relevant.…”

mentioning

confidence: 79%