背景:严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染不仅会导致呼吸道症状,还会导致严重程度不同的神经系统症状。在Omicron变种在世界范围内流行之后,2019年冠状病毒病(COVID-19)的严重神经系统表现,如高热惊厥,脱髓鞘病,和脑血管疾病,已被报道。然而,COVID-19患者的急性脑病报告相当有限.特别是在细胞因子风暴诱导的出血性休克和脑病综合征(HSES)方面,没有报告与COVID-19相关的病例。
方法:我们描述了一个8岁女孩的案例,该女孩出现了与小儿SARS-CoV-2感染相关的致命HSES。癫痫持续状态发生在发烧和腹泻发作后,持续至少一个小时。昏迷后出现循环衰竭,并最终导致发烧后2天内死亡。在三个连续的血清样本中测量的48种细胞因子和趋化因子的分析显示,干扰素(IFN)-γ,白细胞介素(IL)-6,IL-10,IL-17A,肿瘤坏死因子(TNF)-a,IL-8,干扰素γ诱导蛋白(IP)-10和单核细胞趋化蛋白(MCP)-1在意识障碍发作后一小时内增加。
结论:这里,我们描述了一例致命的暴发性脑病,由于与COVID-19相关的HSES而迅速进展。在这种情况下观察到高水平的细胞因子和趋化因子可能是由于SARS-CoV-2相关的细胞因子风暴。本研究是第一例COVID-19相关的HSES病例。
BACKGROUND: Infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead not only to respiratory symptoms but also to neurologic symptoms with various levels of severity. After the worldwide prevalence of Omicron variant, severe neurological manifestations of coronavirus disease 2019 (COVID-19) such as febrile seizure, demyelinating disease, and cerebrovascular disease, have been reported. However,
reports of acute encephalopathy in patients with COVID-19 are quite limited. Especially in terms of cytokine storm-inducing hemorrhagic shock and encephalopathy syndrome (HSES), there is no
case reported related to COVID-19.
METHODS: We describe the
case of an 8-year-old girl who presented with fatal HSES associated with pediatric SARS-CoV-2 infection. Status epilepticus occurs after the onset of fever and diarrhea and lasted for at least an hour. Unconsciousness was followed by circulatory failure and ultimately leading to death within 2 days after the fever onset. Analysis of forty-eight cytokines and chemokines measured in three consecutive serum samples revealed that interferon (IFN)-γ, interleukin (IL)-6, IL-10, IL-17A, tumor necrosis factor (TNF)-a, IL-8, Interferon gamma inducible protein (IP)-10, and Monocyte chemoattractant protein (MCP)-1, were increased within an hour after the onset of impaired consciousness.
CONCLUSIONS: Here, we describe a
case of fatal fulminant encephalopathy with rapid progression because of HSES associated with COVID-19. High levels of cytokines and chemokines observed in this case may be because of the SARS-CoV-2-associated cytokine storm. This study is the first COVID-19-associated
case of HSES.