J Neurocrit Care.  2022 Dec;15(2):131-135. 10.18700/jnc.220078.

Successful treatment of post–COVID-19 acute disseminated encephalomyelitis with urgent immunotherapy and neurointensive management: a case report

• Lee JS
• Kim HJ
• Kim JG

• KMID: 2538771
• DOI: http://doi.org/10.18700/jnc.220078

Abstract

Background
Acute disseminated encephalomyelitis (ADEM)-like white matter disease, a rare complication of coronavirus disease 2019 (COVID-19), is a potentially life-threatening neurological disorder. The objective of this study was to report the successful treatment of post–COVID-19 ADEM with urgent immunotherapy and neurointensive management.
Case Report
A 53-year-old woman was referred to our hospital with a 2-day history of progressive mental deterioration and was diagnosed with ADEM after COVID-19. The patient's symptoms worsened despite the administration of high-dose steroids, and targeted temperature management was employed to manage brain edema. Additionally, the neurointensivist decided to use intravenous immunoglobulin early for intractable post–COVID-19 ADEM. Her mental status and neuroimaging findings showed rapid improvement at about 3 months after admission.
Conclusion
This case highlights that if the patient's symptoms worsen despite high-dose steroid administration in the acute stage, early use of intravenous immunoglobulin is expected to have a positive effect on the prognosis of patients with post–COVID-19 ADEM.

Keyword

COVID-19; Encephalomyelitis; Acute disseminated; Immunotherapy; Neuroimaging

Figure

• 

  Fig. 1. Serial neuroimaging changes of the patient. (A) Initial magnetic resonance imaging (MRI) showing scattered hyperintense lesions on diffusion-weighted imaging (DWI)/apparent diffusion coefficient (ADC) map/fluid-attenuated inversion recovery (FLAIR) imaging in deep and juxtacortical white matter. A FLAIR high signal intensity in both hemispheric juxtacortical white matter showed more extensive lesions than DWI, suggesting edematous demyelination. (B) Neuroimaging performed during deterioration of the patient. Brain computed tomography showing marked white matter edema with sulcal effacement. There was no significant contrast uptake on T1 or FLAIR enhancement images along the edematous white matter. (C) MRI on hospital day 16 showing more progression and extension of DWI/ADC/FLAIR hyperintensities in the juxtacortical white matter. (D) The last follow-up DWI/ADC/FLAIR performed on the 39th day after admission demonstrating markedly reduced sizes of hyperintense lesions.

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