Covid-19 systemic infection exacerbates pre-existing acute disseminated encephalomyelitis (ADEM).
Covid-19 systemic infection exacerbates pre-existing acute disseminated encephalomyelitis (ADEM).
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DOI：
10.1016/j.jneuroim.2020.577405
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发表时间：
2020-12-15
影响因子：
3.3
通讯作者：
Torbey MT
中科院分区：
文献类型：
--
作者：
Hussein O;Abd Elazim A;Torbey MT
急性播散性脑脊髓炎（ADEM）是一种罕见的诊断成人。它是由于对系统性感染的异常免疫反应，而不是直接的病毒入侵中枢神经系统。在COVID-19全身感染的情况下诊断出ADEM的报告很少。然而，我们报告了一例科萨基诱发的ADEM缓解，但因COVID-19感染而加重。患者在出院至康复机构后不久感染COVID-19。通过CSF PCR病毒检测排除了直接COVID-19神经侵袭。在这两种情况下，患者对脉冲类固醇治疗和血浆置换反应良好。我们假设，COVID-19感染可以通过改变免疫反应来引发最近缓解的ADEM。现在已知COVID-19感染可以产生细胞因子风暴。细胞因子途径激活是已知的参与ADEM的病理。在COVID-19大流行时期，应谨慎安排免疫抑制患者出院至住院康复机构。COVID-19感染可加重急性播散性脑脊髓炎（ADEM）发作。在COVID-19背景下早期识别ADEM对于早期治疗至关重要。经治疗的COVID-19全身感染加重的ADEM预后良好。COVID 19加重的ADEM的诊断取决于CSF病毒检测。应考虑替代住院熟练护理康复的方法。
Acute disseminated encephalomyelitis (ADEM) is an uncommon diagnosis in adults. It is known to be due to an abnormal immune response to a systemic infection rather than direct viral invasion to the central nervous system. There have been few reports of ADEM diagnosed in the setting of COVID-19 systemic infection. However, we report a case of Coxsackie induced ADEM that remitted but got exacerbated by COVID-19 infection. The patient contracted the COVID-19 infection shortly after being discharged to a rehabilitation facility. Direct COVID-19 neuroinvasion was ruled out via CSF PCR testing for the virus. The patient responded well to pulse steroid therapy and plasmapheresis in both occasions. We hypothesize that COVID-19 infection can flare-up a recently remitted ADEM via altering the immune responses. It is known now that COVID-19 infection can produce cytokine storming. Cytokine pathway activation is known to be involved in the pathology of ADEM. Caution regarding discharging immune suppressed patient to the inpatient rehabilitation facility should be made in the era of COVID-19 pandemic. COVID-19 infection can exacerbate an acute disseminated encephalomyelitis (ADEM) attack. Early recognition of ADEM in the setting of COVID-19 is crucial for early treatment. Treated ADEM exacerbated by COVID-19 systemic infection carries a good prognosis. Diagnosis of COVID 19-exacerbated ADEM depends on CSF viral testing. Alternative methods to inpatient skilled nursing rehabilitation should be considered.
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