Seizure in acute COVID-19 infection: Not just a meningoencephalitis

ABSTRACT

Seizure is rarely a presenting symptom of COVID-19 infection. Neurological manifestations happen through direct invasion into the nervous system or through activation of the systemic inflammation. A healthy 13-year-old boy presented with one episode of seizure and fever for 2 days. On arrival, he was in post-ictal, febrile with stable haemodynamics. In view of poor Glasgow coma scale recovery, he was intubated and antibiotics were also given. Computed tomography brain contrast showed meningoencephalitis changes. Biochemistry tests from lumbar puncture revealed viral pictures while cultures were negative. The polymerase chain reaction was positive for COVID-19. While in the intensive care unit, he had hypotension and echocardiogram demonstrated pericardial effusion and reduced ejection fraction. He was treated for multisystem inflammatory syndrome (MIS-C) and given immunoglobulin and methylprednisolone. His condition improved and no seizure reported. After 7 days, he developed another seizure which then he was decided for plasma exchange therapy. He recovered well and was discharged after 31 days of admission. The incidence of encephalitis amongst COVID-19 patient was 0.215%. Less than 1% of paediatric population with confirmed SARS-CoV-2 infection is prone to develop MIS-C as a consequence of hyperinflammatory state. It typically occurs within 2-6 weeks after SARS-CoV2 infection. This case depicts otherwise as this patient developed MISC during his active SARS-CoV2 infection. Our case highlights the need to look for indicators of MIS-C particularly in COVID-19 individuals who do not present with typical symptoms as the treatment is substantially different.