Pediatric Infection and Vaccine

  • 제30권3호
  • /
  • Pages.180-187
  • /
  • 2023
  • /
  • 2384-1079(pISSN)
  • /
  • 2384-1087(eISSN)
대한소아감염학회 (The Korean Society of Pediatric Infectious Diseases)
권호 표지
DOI QR코드

DOI QR Code

국내 소아에서 심한 COVID-19 뇌염에서 성공적으로 회복된 1례

The Case of Successful Recovery From Severe Encephalitis in a COVID-19 Pediatric Patient in Korea

  • 김은정 (고대구로병원 소아청소년과) ;
  • 기소현 (고대구로병원 소아청소년과) ;
  • 정혜나 (고대구로병원 영상의학과) ;
  • 윤윤선 (고대구로병원 소아청소년과) ;
  • 은백린 (고대구로병원 소아청소년과)
  • EunJeong Kim (Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine) ;
  • So Hyun Ki (Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Hye Na Jung (Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Yoonsun Yoon (Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine) ;
  • BaikLin Eun (Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine)
  • 투고 : 2023.09.15
  • 심사 : 2023.11.01
  • 발행 : 2023.12.25
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

2023년 9월까지 19세이하소아청소년인구의 90% 이상에서코로나바이러스감염증-19 (coronavirus disease 2019, COVID-19) 감염력이 있으며, 그중 40-60%에서 두통, 경련발작, 뇌염 등의 신경학적 증상이 보고되고 있다. 본 증례에서 저자들은 severe acute respiratory syndrome coronavirus 2 감염 후 경련과 의식 변화로 내원, COVID-19 뇌염으로 진단하여 정맥내 면역글로불린, 고용량 스테로이드, 항바이러스제, 항경련제 투여 등의 적극적인 치료로 회복된 3세 여자 환자를 보고하고자 한다. 환자는 입원 39일차 말하기와 혼자 걷기가 가능한 상태로 퇴원하였고 발병 1년이 지난 시점, 경한 언어 지연을 보이나 전반적으로 좋은 예후를 보이고 있다. COVID-19 뇌염 환자에서 조기 발견과 적극적인 치료가 긍정적인 예후와 연관됨을 본 증례를 통하여 보고하는 바이다.

In Korea, >90% of children and adolescents aged <19 years have been infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) since 2020. Among confirmed cases of pediatric coronavirus disease 2019 (COVID-19), 40-60% of patients developed neurologic symptoms such as seizures, headache, and encephalitis. Herein, we report the case of a 3-year-old female patient with SARS-CoV-2 infection who presented with seizures and altered consciousness and was diagnosed with COVID-19 encephalitis. The patient recovered after treatment with intravenous immunoglobulin, high-dose steroids, anti-seizure drugs, and an anti-viral agent. She was discharged after regaining the ability to speak words and walk alone on hospital day 39. Complete recovery was observed at the 1-year follow-up. The findings in this case suggest that early detection and active intervention is associated with better outcomes in patients with COVID-19 encephalitis.

키워드

참고문헌

  1. Korea Disease Control and Prevention Agency (KDCA). Cases in Korea [Internet]. Seoul: KDCA; 2023 [cited 2023 Sep 4]. Available from: https://ncov.kdca.go.kr.
  2. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol 2020;77:683-90.  https://doi.org/10.1001/jamaneurol.2020.1127
  3. Kim HK, Cho YJ, Lee SY. Neurological manifestations in patients with COVID-19: experiences from the central infectious diseases hospital in South Korea. J Clin Neurol 2021;17:435-42. https://doi.org/10.3988/jcn.2021.17.3.435
  4. Lee H, Choi S, Park JY, Jo DS, Choi UY, Lee H, et al. Analysis of critical COVID-19 cases among children in Korea. J Korean Med Sci 2022;37:e13. 
  5. Valderas C, Mendez G, Echeverria A, Suarez N, Julio K, Sandoval F. COVID-19 and neurologic manifestations: a synthesis from the child neurologist's corner. World J Pediatr 2022;18:373-82.  https://doi.org/10.1007/s12519-022-00550-4
  6. Kumar R. Understanding and managing acute encephalitis. F1000 Res 2020;9:F1000 Faculty Rev-60. 
  7. Urso L, Distefano MG, Cambula G, Colomba AI, Nuzzo D, Picone P, et al. The case of encephalitis in a COVID-19 pediatric patient. Neurol Sci 2022;43:105-12.  https://doi.org/10.1007/s10072-021-05670-9
  8. Siahaan YM, Puspitasari V, Pangestu A. COVID-19-associated encephalopathy: systematic review of case reports. J Clin Neurol 2022;18:194-206.  https://doi.org/10.3988/jcn.2022.18.2.194
  9. Burr T, Barton C, Doll E, Lakhotia A, Sweeney M. N-methyl-d-aspartate receptor encephalitis associated with COVID-19 infection in a toddler. Pediatr Neurol 2021;114:75-6.  https://doi.org/10.1016/j.pediatrneurol.2020.10.002
  10. Pilotto A, Masciocchi S, Volonghi I, De Giuli V, Caprioli F, Mariotto S, et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) encephalitis is a cytokine release syndrome: evidences from cerebrospinal fluid analyses. Clin Infect Dis 2021;73:e3019-26.  https://doi.org/10.1093/cid/ciaa1933
  11. Lindan CE, Mankad K, Ram D, Kociolek LK, Silvera VM, Boddaert N, et al. Neuroimaging manifestations in children with SARS-CoV-2 infection: a multinational, multicentre collaborative study. Lancet Child Adolesc Health 2021;5:167-77.  https://doi.org/10.1016/S2352-4642(20)30362-X
  12. Graham EL, Koralnik IJ, Liotta EM. Therapeutic approaches to the neurologic manifestations of COVID-19. Neurotherapeutics 2022;19:1435-66.  https://doi.org/10.1007/s13311-022-01267-y
  13. Grundmann A, Wu CH, Hardwick M, Baillie JK, Openshaw PJ, Semple MG, et al. Fewer COVID-19 neurological complications with dexamethasone and remdesivir. Ann Neurol 2023;93:88-102.  https://doi.org/10.1002/ana.26536
  14. Poyhonen H, Setanen S, Isaksson N, Nyman M, Nyman A, Peltola V, et al. Neurological and cognitive performance after childhood encephalitis. Front Pediatr 2021;9:646684. 
  15. Brisca G, Marini C, Buratti S, Mariani M, Tortora D, Morana G, et al. Acute pediatric encephalitis: etiology, course, and outcome of a 12-year single-center immunocompetent cohort. J Neurol 2023;270:5034-47.  https://doi.org/10.1007/s00415-023-11847-3
  16. Chang YM, Chen CH, Wang JN, Cheng CM, Tu YF, Shen CF. Case report: Distinct neurologic manifestation and cytokine profile of a child with COVID-19-associated acute fulminant encephalitis. Front Med (Lausanne) 2023;10:1209656. 
  17. Park DS, Yoon SW, Kim DH, Kwon YS. Acute necrotizing encephalopathy in children with COVID-19 accompanied by multisystem inflammatory syndrome. Ann Child Neurol 2023;10:26815. 
  18. Abdelhady M, Husain MA, Hawas Y, Elazb MA, Mansour LS, Mohamed M, et al. Encephalitis following COVID-19 vaccination: a systematic review. Vaccines (Basel) 2023;11:576. 
  19. Kim KM, Kim SY, Song MK, Kim JY, Cho A, Park JY. Rapid progression to brainstem encephalitis caused by enterovirus 71 without throat and skin lesions after a one-day fever. Pediatr Infect Vaccine 2023;30:91-6.  https://doi.org/10.14776/piv.2023.30.e7
  20. Islam MA, Cavestro C, Alam SS, Kundu S, Kamal MA, Reza F. Encephalitis in patients with COVID-19: a systematic evidence-based analysis. Cells 2022;11:2575.