The case of fatal acute hemorrhagic necrotizing encephalitis in a two-month-old boy with Covid-19.

SARS-CoV-2 infection in healthy children is usually benign. However, severe, life-threatening cases have previously been reported, notably in infants. We must be aware that data on the natural history of COVID-19 are still full of gaps, especially as far as the pediatric population is concerned. Therefore, it is important to describe rare manifestations of SARS-CoV-2 acute infection in children. Here we present the case of acute hemorrhagic necrotizing encephalitis (AHNE) in a previously healthy, 2-month-old male infant with SARS-CoV-2 infection. After 2 days of fever with signs of respiratory tract infection, neurological manifestations appeared: irritability, nystagmus, agitation then apathy. As a consequence of apnea, he required emergent intubation and was transferred to our PICU. Brain MRI revealed diffuse areas of oedema associated with numerous symmetrical changes with punctate hemorrhages in basal ganglia, thalami, brainstem, and cerebral gray matter. CSF was clear with pleocytosis 484 cells/µl, elevated lactic acid and protein. Despite broad microbiological testing, only SARS-CoV2 was detected in PCR nasal swab. Therefore, acute hemorrhagic necrotizing encephalitis (AHNE) as a result of COVID-19 was the most probable diagnosis. The outcome was unfavorable - brain death was confirmed, life support was withdrawn.

Gastrointestinal motility disorders in patients with anorexia nervosa - a review of the literature.

Anorexia nervosa is a disease carrying havoc on many levels of the body functioning. The presence of numerous somatic complications as a consequence of starvation is an important part of the clinical picture of this disease. Symptoms of the gastrointestinal tract are one of the most common complaints reported by patients, especially in the initial period of realimentation. Most common symptoms are associated with gastrointestinal motility disorders. The available data show that as many as half of patients suffering from anorexia nervosa manifest significant gastrointestinal motility disorders (incomplete relaxation of the upper and lower oesophageal sphincter, impaired compliance of the stomach, delayed gastric emptying, intestinal transit extension, decreased motility of the rectum and anus). These disorders along with gastrointestinal tract ailments may impede the restoration of proper diet, if not detected early and treated. There are relatively few studies on gastrointestinal motility disorders in patients suffering from anorexia nervosa, which do not clearly answer the question whether these disorders are genetic, or result from cachexia and whether they disappear along with the restoration of the normal body weight. No reference of research results to the clinical practice, and the lack of standard procedures for diagnosis and treatment of gastrointestinal disorders in patients with anorexia nervosa are significant problems for specialists in the field of psychiatry and gastroenterology.