Reader response: Acute disseminated encephalomyelitis after SARS-CoV-2 infection
Islam Gad Elrap Ahmed IbrahimElmalky, Lecturer of Neurology, South valley University, Faculty of Medicine, Neurology Department
Submitted June 17, 2020
Novi et al.1 presented a nice and informative case. The small-sized lesions with restricted diffusion in MRI might be consistent with ischemic lesions because of vasculitis. High protein and oligoclonal band in CSF could also be present in vasculitis. The presence of optic neuritis and cord lesions is possible in vasculitis.2 Investigations are needed—like MRA-brain and serum-ANCA (Antineutrophil cytoplasmic Antibodies)—to exclude probable vasculitis.3 It is well known that definite vasculitis is diagnosed by brain biopsy.3 The binding of COVID-19 to the ACEI2 (Angiotensin Converting Enzyme Inhibitor-2) that is expressed in several organs—especially in endothelial cells—may lead to endothelialitis.4 Vasculitis is common in late adult and female patients while ADEM is common in young and male patients.2 Vasculitis is another Differential Diagnosis in this case.
Novi G, Rossi T, Pedemonte E, et al. Acute disseminated encephalomyelitis after SARS-CoV-2 infection. Neurol Neuroimmunol Neuroinflamm 2020;7:e797.
Rice CM, Scolding NJ. The diagnosis of primary central nervous system vasculitis. Pract Neurol 2020;20:109–114.
Cho TA, Bhattacharyya S, Helfgott S, editors. Neurorheumatology: A Comprehensive Guide to Immune-Mediated Disorders of the Nervous System. Switzerland: Springer; 2019.
Varga Z, Flammer AJ, Steiger P, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet 2020;395:1417–1418.
Novi et al.1 presented a nice and informative case. The small-sized lesions with restricted diffusion in MRI might be consistent with ischemic lesions because of vasculitis. High protein and oligoclonal band in CSF could also be present in vasculitis. The presence of optic neuritis and cord lesions is possible in vasculitis.2 Investigations are needed—like MRA-brain and serum-ANCA (Antineutrophil cytoplasmic Antibodies)—to exclude probable vasculitis.3 It is well known that definite vasculitis is diagnosed by brain biopsy.3 The binding of COVID-19 to the ACEI2 (Angiotensin Converting Enzyme Inhibitor-2) that is expressed in several organs—especially in endothelial cells—may lead to endothelialitis.4 Vasculitis is common in late adult and female patients while ADEM is common in young and male patients.2 Vasculitis is another Differential Diagnosis in this case.
Disclosure
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References