An Unusual Case of Acute Hemorrhagic Necrotizing Encephalomyelitis in a COVID-19 Patient.

Acute disseminated encephalomyelitis, also known as ADEM, is a rare autoimmune demyelinating disease of the central nervous system that has been correlated with viral infections and vaccinations and has a range of presentations, where it can present as a mild neurological dysfunction or more severe manifestations ending in chronic neurological sequelae or even death; therefore, it is considered to be a diagnostic challenge. We present a case of ADEM diagnosed in a previously healthy male patient with a recent infection of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). Early diagnosis and management with intravenous immunoglobulins held the key to a good outcome.

Safety of biologics in inflammatory bowel disease patients with COVID-19.

BACKGROUND: Patients with Inflammatory bowel disease (IBD) remain highly concerned that either their disease or medications-namely, biologics-may increase the risk of severe coronavirus-2019 (COVID-19). We aimed to assess the safety of biologics in Inflammatory bowel disease (IBD) patients with COVID-19. METHODS: We systematically reviewed multiple databases to find relevant articles reporting the effect of biologics on "severe" COVID-19 in IBD patients. Those in the form of case series (> 10 patients), case-control, and cohort studies were included. Severe COVID-19 was defined as intensive care unit (ICU) admission, mechanical ventilation, and/or mortality. Pooled analysis with multivariate regression was performed. RESULTS: A total of 12 studies with 2681 patients were included. The proportion of females was (48.3%, 95% confidence interval (CI) 47.0-49.5%). The proportion of UC patients was (44.8%, 95% CI 41.0-48.5%). Overall, in IBD patients, the need for mechanical ventilation, intensive care unit (ICU) admission, and mortality was 5.1%, 6.1%, and 4.5%, respectively. Use of biologics did not show a moderating effect on mechanical ventilation (p = 0.68), ICU admission (p = 0.27), or mortality (p = 0.20). CONCLUSIONS: Our findings advocate for the continued biologic therapy in IBD patients during the COVID-19 pandemic. Nevertheless, the incidence, severity, and outcomes related to COVID-19 in IBD patients' needs to be reassessed as data continues to emerge.