DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20214170

Paediatric anti-GABAB receptor encephalitis associated with SARS-CoV-2 (COVID-19) infection

Nidhi Shivanna Premakumari, Sudha Rudrappa, Pratibha Manjunath Patagar

Abstract


Though we are approaching the end of second wave of COVID pandemic, we are still unrevealing the various presentation this viral infection can result in. There are few cases reported to have anti NMDA autoimmune encephalitis associated with COVID-19 infection or MIS-C. Here we are reporting one of its variants that was anti-GABAB receptor encephalitis associated with COVID-19 infection. We are reporting a 9 years old female child who was a known case of seizure disorder and on regular medications presented on 4th day of RT-PCR positive status for COVID-19 with complains of convulsions which was managed with antiepileptics. On day 6 of hospitalization she had autonomic instability in the form of tachyarrhythmia, repitation of speech, sudden outburst of laughter and on day 7 child landed in status epilepticus. Autoimmune encephalitis suspected secondary to COVID-19 infection and the child was started on IVIG but not much of improvement seen with this. CSF analysis showed weakly positive anti GABAB antibodies and child had persistently elevated inflammatory markers hence started on high dose corticosteroid. MIS-C ruled out. Child showed drastic improvement both clinical and biochemical after high dose corticosteroids. Prompt treatment with IVIG/corticosteroids have shown a drastic improvement in our child just like in any other autoimmune encephalitis. Though further detailed study is required to prove its exact mechanism in COVID-19 infection, it should be thought of when appropriate and prompt early initiation of therapy will help us reduce morbidity and mortality associated with it.


Keywords


Autoimmune encephalitis, Anti GABAB antibodies, IVIG, High dose corticosteroids

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References


Burr T, Barton C, Doll E, Lakhotia A, Sweeney M. N-Methyl-d-aspartate receptor encephalitis associated with COVID-19 infection in a toddler. Pediatr Neurol. 2021;114:75-6.

McAbee GN, Brosgol Y, Pavlakis S, Agha R, Gaffoor M. Encephalitis associated with COVID-19 infection in an 11-year-old child. Pediatr Neurol. 2020;109:94.

Garg D, Mohammad SS, Suvasini Sharma S. Autoimmune encephalitis in children an update. Indian Pediatr. 2020;57(7):662-70.

Wu Y, Xu X, Chen Z, Duan J, Hashimoto K, Yang L, et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun. 2020;87:18-22.

Benarroch EE. GABAB receptors: structure, functions and clinical implications. Neurology. 2012;78(8):578-84.

Höftberger R, Titulaer MJ, Sabater L, Dome B, Rózsás A, Hegedus B, et al. Encephalitis and GABAB receptor antibodies: novel findings in a new case series of 20 patients. Neurology. 2013;81(17):1500-6.

Bamford A, Crowe BHA, Hacohen Y, Lin J, Clarke A, Tudor-Williams G, et al. Pediatric herpes simplex virus encephalitis complicated by N-methyl-D-aspartate receptor antibody encephalitis. J Pediatric Infect Dis Soc. 2015;4(2):17-21.

Kliegman RM, Geme JS. Nelson textbook of pediatrics. 21 ed. Philadelphia: Elsevier publications; 2021: 3179-85.

Clinical approach to the diagnosis of autoimmune encephalitis in pediatric patients. Neurol Neuroimmunol Neuroinflamm. 2020;7(4):730.