A recently published case study described a case of severe encephalopathy related to Coronavirus Disease 2019 (COVID-19) in a pediatric patient who developed clinical features characteristic of akinetic mutism. This was published in a recent issue of Neurology.
The patient was a 16 year old female who developed anxiety, insomnia, anorexia, paranoia and ritualistic behaviors 3 days after developing a sore throat. After the onset of visual hallucinations, she was referred to the emergency room for an urgent psychiatric evaluation. The patient’s temperature rose to 38.6 ° C at the time of their presence.
Clinicians tested and recognized severe coronavirus 2 (SARS-CoV-2) with acute respiratory syndrome on up to 6 nasopharyngeal swabs in the following weeks. During the first 10 days after admission, the patient remained pyrexial and tachycardic.
This patient’s visual and auditory hallucinations included jumping lions and fears that she had harmed her family members. She developed mutism 5 days after ingestion and showed little to no voluntary motor activity. The patient made repeated scissoring movements with her legs and circular movements with her arms; This lasted for hours in the first two weeks of the clinical course.
Treatment included 1 course of 0.4 mg / kg / day intravenous immunoglobulin (IVIG) over a period of 5 days from the 3rd day of admission. The patient then received 1 g intravenous methylprednisolone per day for 3 days. While doctors initiated a second IVIG course on day 14, it was canceled after a widespread rash developed.
Approximately 4 weeks after the initial presentation, the patient showed signs of increased voluntary movement, language attempts, and a reduction in limb stiffness. Her walk remained hesitant, but on Day 98 she was finally released home. She still needed significant washing and feeding assistance and was waiting to be admitted to a rehabilitation facility.
The patient continued to experience significant cognitive and physical difficulties 4 months after symptoms appeared, but these symptoms began to improve after 6 months. At this point, her neurological exam normalized. The patient’s language also became fluent with an engaged affect. Since then, she has regained her daily activities and resumed her local dance classes. Even so, she still has memory problems and complaints of fatigue.
Regarding this case, the study authors stated that “this was a devastating, suspected parainfectious encephalopathy with a slow and incomplete recovery to date”. They came to the conclusion that “the patient ultimately needs close, long-term neurological and psychiatric observation”.
Gaughan M., Connolly S., O’Riordan S. et al. Pediatric parainfectious encephalitis associated with COVID-19. Published online January 4, 2021. Neurology. doi: 10.1212 / WNL.0000000000011476