COVID-19-associated acute disseminated encephalomyelitis with Overlap syndrome in a teenager: A clinical case
DOI:
https://doi.org/10.37800/RM.3.2025.555Keywords:
Acute disseminated encephalomyelitis, COVID-19, SARS-CoV-2, scleroderma, dermatomyositis, Overlap syndrome, childrenAbstract
Relevance: In addition to respiratory symptoms, the SARS-CoV-2 virus can cause various neurological symptoms, both in the acute and late periods. One of the most common neuroimaging manifestations of COVID-19 and the most frequently described demyelinating syndrome in children associated with this infection was acute disseminated encephalomyelitis (ADEM). The conducted literature search did not reveal any described cases of Overlap syndrome in combination with central nervous system (CNS) damage associated with COVID-19 in children.
The study aimed to present a clinical case of COVID-19-associated acute disseminated encephalomyelitis in a 14-year-old girl with overlap syndrome to inform doctors about the possible long-term consequences of COVID-19.
Materials and methods: This article presents a rare clinical case of ADEM in combination with Overlap-syndrome (a combination of juvenile scleroderma and dermatomyositis) associated with COVID-19.
Results: In the described case, COVID-19-associated ADEM debuted with psychoemotional disorders, followed by aphasia, ataxia, and pelvic dysfunction. MRI of the brain showed large pathological foci in the frontal-parietal-temporal region, basal ganglia, globus pallidus of both cerebral hemispheres, and the corpus callosum, which had a hyperintense signal on T2WI and FLAIR and intensely accumulated the contrast agent. During the examination, the girl also showed a positive antinuclear factor on the HEp-2 cell substrate, as well as antibodies to DFS70 and antibodies to Scl-70. Based on the results obtained, Overlap syndrome was diagnosed: juvenile scleroderma combined with dermatomyositis and central nervous system damage in the form of acute disseminated encephalomyelitis associated with COVID-19. Treatment with high doses of methylprednisolone and intravenous immunoglobulin gave good results.
Conclusion: The presented clinical case shows that ADEM is a potential neurological complication of COVID-19 in children. Physicians should be cautious when evaluating patients with a history of COVID-19 and consider ADEM in the differential diagnosis, as early diagnosis and treatment are crucial in determining the outcome of this disease.
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