Acute Hemorrhagic Leukoencephalitis in a Pediatric Patient with COVID-19 Infection: A Case Report

ABSTRACT

Case Diagnosis This is a pediatric case of acute hemorrhagic leukoencephalitis (AHLE). Case Description or Program Description A 6-yearold female with history of Hemoglobin SC disease presented to the hospital with a two-day history of fever, cough, congestion, and positive COVID PCR test. She became apneic with oxygen saturations in the 70s, hypotensive, and incontinent of urine, ultimately requiring intubation and an intensive care unit stay. MRI brain revealed innumerable microhemorrhages within the superior greater than infratentorial periventricular and subcortical white matter. Blood and urine cultures and extensive workup including cerebrospinal fluid studies were negative, other than elevated myelin basic protein. The patient underwent treatment with intravenous steroids and IVIG with subsequent clinical improvement. Setting(s) Acute care hospital and acute inpatient rehabilitation hospital. Assessment/Results: Neurology concluded that the brain MRI findings were likely due to AHLE in the setting of acute COVID infection. The patient was ultimately extubated and transitioned from tube feeds to a regular diet with thin liquids. She discharged from acute rehabilitation ambulating 150 feet and walking up stairs. She displayed deficits in cognition and communication that improved throughout her rehabilitation stay. Discussion (relevance) AHLE is typically seen in adults and mortality is reported as high as 70%. Here we present a case in a pediatric patient with favorable neurological outcomes. Conclusion(s) Although AHLE is more common in the adult population, it may present in the pediatric patient in the setting of COVID infection. Increased awareness can lead to early diagnosis and may contribute to positive functional outcomes.