Medical Dialogues
  • Dermatology
Login Register
This site is intended for healthcare professionals only
Login Register
  • MD Brand Connect
  • Vaccine Hub
  • MDTV
    • Breaking News
    • Medical News Today
    • Health News Today
    • Latest
    • Journal Club
    • Medico Legal Update
    • Latest Webinars
    • MD Shorts
    • Health Dialogues
  • Fact Check
  • Health Dialogues
Medical Dialogues
  • Medical News & Guidelines
      • Anesthesiology
      • Cardiology and CTVS
      • Critical Care
      • Dentistry
      • Dermatology
      • Diabetes and Endocrinology
      • ENT
      • Gastroenterology
      • Medicine
      • Nephrology
      • Neurology
      • Obstretics-Gynaecology
      • Oncology
      • Ophthalmology
      • Orthopaedics
      • Pediatrics-Neonatology
      • Psychiatry
      • Pulmonology
      • Radiology
      • Surgery
      • Urology
      • Laboratory Medicine
      • Diet
      • Nursing
      • Paramedical
      • Physiotherapy
  • Health news
      • Doctor News
      • Government Policies
      • Hospital & Diagnostics
      • International Health News
      • Medical Organization News
      • Medico Legal News
      • NBE News
      • NMC News
  • Fact Check
      • Bone Health Fact Check
      • Brain Health Fact Check
      • Cancer Related Fact Check
      • Child Care Fact Check
      • Dental and oral health fact check
      • Diabetes and metabolic health fact check
      • Diet and Nutrition Fact Check
      • Eye and ENT Care Fact Check
      • Fitness fact check
      • Gut health fact check
      • Heart health fact check
      • Kidney health fact check
      • Medical education fact check
      • Men's health fact check
      • Respiratory fact check
      • Skin and hair care fact check
      • Vaccine and Immunization fact check
      • Women's health fact check
  • AYUSH
    • Ayurveda
    • Homeopathy
    • Siddha
    • Unani
    • Yoga
  • State News
      • Andaman and Nicobar Islands
      • Andhra Pradesh
      • Arunachal Pradesh
      • Assam
      • Bihar
      • Chandigarh
      • Chattisgarh
      • Dadra and Nagar Haveli
      • Daman and Diu
      • Delhi
      • Goa
      • Gujarat
      • Haryana
      • Himachal Pradesh
      • Jammu & Kashmir
      • Jharkhand
      • Karnataka
      • Kerala
      • Ladakh
      • Lakshadweep
      • Madhya Pradesh
      • Maharashtra
      • Manipur
      • Meghalaya
      • Mizoram
      • Nagaland
      • Odisha
      • Puducherry
      • Punjab
      • Rajasthan
      • Sikkim
      • Tamil Nadu
      • Telangana
      • Tripura
      • Uttar Pradesh
      • Uttrakhand
      • West Bengal
  • Medical Education
      • Ayush Education News
      • Dentistry Education News
      • Medical Admission News
      • Medical Colleges News
      • Medical Courses News
      • Medical Universities News
      • Nursing education News
      • Paramedical Education News
      • Study Abroad
  • Industry
      • Health Investment News
      • Health Startup News
      • Medical Devices News
      • Pharma News
      • Pharmacy Education News
      • Industry Perspective
  • MDTV
      • Health Dialogues MDTV
      • Health News today MDTV
      • Latest Videos MDTV
      • Latest Webinars MDTV
      • MD shorts MDTV
      • Medical News Today MDTV
      • Medico Legal Update MDTV
      • Top Videos MDTV
      • Health Perspectives MDTV
      • Journal Club MDTV
      • Medical Dialogues Show
This site is intended for healthcare professionals only
LoginRegister
Medical Dialogues
LoginRegister
  • Home
  • Medical news & Guidelines
    • Anesthesiology
    • Cardiology and CTVS
    • Critical Care
    • Dentistry
    • Dermatology
    • Diabetes and Endocrinology
    • ENT
    • Gastroenterology
    • Medicine
    • Nephrology
    • Neurology
    • Obstretics-Gynaecology
    • Oncology
    • Ophthalmology
    • Orthopaedics
    • Pediatrics-Neonatology
    • Psychiatry
    • Pulmonology
    • Radiology
    • Surgery
    • Urology
    • Laboratory Medicine
    • Diet
    • Nursing
    • Paramedical
    • Physiotherapy
  • Health news
    • Doctor News
    • Government Policies
    • Hospital & Diagnostics
    • International Health News
    • Medical Organization News
    • Medico Legal News
    • NBE News
    • NMC News
  • Fact Check
    • Bone Health Fact Check
    • Brain Health Fact Check
    • Cancer Related Fact Check
    • Child Care Fact Check
    • Dental and oral health fact check
    • Diabetes and metabolic health fact check
    • Diet and Nutrition Fact Check
    • Eye and ENT Care Fact Check
    • Fitness fact check
    • Gut health fact check
    • Heart health fact check
    • Kidney health fact check
    • Medical education fact check
    • Men's health fact check
    • Respiratory fact check
    • Skin and hair care fact check
    • Vaccine and Immunization fact check
    • Women's health fact check
  • AYUSH
    • Ayurveda
      • Ayurveda Giuidelines
      • Ayurveda News
    • Homeopathy
      • Homeopathy Guidelines
      • Homeopathy News
    • Siddha
      • Siddha Guidelines
      • Siddha News
    • Unani
      • Unani Guidelines
      • Unani News
    • Yoga
      • Yoga Guidelines
      • Yoga News
  • State News
    • Andaman and Nicobar Islands
    • Andhra Pradesh
    • Arunachal Pradesh
    • Assam
    • Bihar
    • Chandigarh
    • Chattisgarh
    • Dadra and Nagar Haveli
    • Daman and Diu
    • Delhi
    • Goa
    • Gujarat
    • Haryana
    • Himachal Pradesh
    • Jammu & Kashmir
    • Jharkhand
    • Karnataka
    • Kerala
    • Ladakh
    • Lakshadweep
    • Madhya Pradesh
    • Maharashtra
    • Manipur
    • Meghalaya
    • Mizoram
    • Nagaland
    • Odisha
    • Puducherry
    • Punjab
    • Rajasthan
    • Sikkim
    • Tamil Nadu
    • Telangana
    • Tripura
    • Uttar Pradesh
    • Uttrakhand
    • West Bengal
  • Medical Education
    • Ayush Education News
    • Dentistry Education News
    • Medical Admission News
    • Medical Colleges News
    • Medical Courses News
    • Medical Universities News
    • Nursing education News
    • Paramedical Education News
    • Study Abroad
  • Industry
    • Health Investment News
    • Health Startup News
    • Medical Devices News
    • Pharma News
      • CDSCO (Central Drugs Standard Control Organisation) News
    • Pharmacy Education News
    • Industry Perspective
  • Home
  • Pediatrics and Neonatology
  • Pediatrics and Neonatology Cases
  • Rare neurological...

Rare neurological presentation of PIMS-TS: Acute hemorrhagic encephalomyelitis- BMJ case report

Written By : dr anusha |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2021-08-17T09:00:08+05:30  |  Updated On 17 Aug 2021 9:00 AM IST
Rare neurological presentation of PIMS-TS: Acute hemorrhagic encephalomyelitis- BMJ case report
  • facebook
  • twitter
  • linkedin
  • whatsapp
  • Telegram
  • Email

Pediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS) is a novel disease, with varied clinical manifestations being reported from all over the world. Multiple neurological manifestations of PIMS-TS have been reported such as encephalitis, Gullian-Barre syndrome, meningitis and encephalitis previously, AHEM has been less commonly reported.

Dr.Prasanna et al have reported a very rare case PIMS-TIMS presenting as Acute Hemorrhagic encephalomyelitis in the latest issue of Journal of Pediatric Critical Care.

A one year old boy was admitted to PICU with history of fever,vomiting and decreased oral intake for 3 days. On examination child was irritable ,GCS of 11/15 with tachycardia, hypotension and absent peripheral pulses. System examination revealed mild hepatomegaly with absent meningeal signs. He was immediately started on fluid resuscitation with inotropic support, supplemental oxygen and other supportive measures.

Initial blood investigations showed marked neutrophilic leukocytosis(14,400/cumm), thrombocytopenia (40000/cumm) and elevated inflammatory markers(procalcitonin:9.9mcg/L and ferritin:>2000mcg/L). He also fulminant hepatic failure evidenced by deranged LFT. ABG was suggestive of severe metabolic acidosis with elevated lactate. Surprisingly his COVID IgM/IgG antibodies were positive along with positive dengue IgM antibodies.

Based on above findings a possibility of septic shock,PIMS-TS with MODS and dengue shock were considered and child was initiated on broad-spectrum IV antibiotics. Later on blood cultures were reported negative and screening ECHO was normal with no coronary dilations.

As child had fever more than 3 days,hypotensive shock,coagulopathy, no other focus of infection,elevated procalcitonin and positive COVID antibodies, a diagnosis of PIMS-TS was confirmed as per WHO criteria. After initiating IVIg(intravenous immunoglobulin) and pulse methylprednisolone child showed clinical improvement with stable hemodynamic, improving liver function tests and decreased procalcitonin.

On day 4 of PICU stay child developed a generalized seizure which was controlled with levetiracetam. He had fluctuations in sensorium hence MRI brain was done showing feature suggestive of ADEM. He was continued on pulse steroids and other supportive measures. Subsequently child had recurrence of fever spikes with decreased counts. Bone marrow examination ruled out possibility of hemophagocytosis. Cerebrospinal fluid (CSF) examination showed increased protein and polymorphic pleocytosis with a negative CSF viral panel,and pan bacterial PCR panel. In view of worsening sensorium, the child was intubated, mechanically ventilated and neuroprotective measures were initiated.

Electroencephalography showed generalized slowing, suggestive of encephalopathy.Repeat MRI brain showed features suggestive of hemorrhagic ADEM.With the worsening condition parents shifted child to another facility where child succumbed to the illness.

As presentation similar to inflammatory syndrome with CNS involvement in the early course of disease, the possibility of dengue encephalitis was considered unlikely in this case. Also Postinfectious ADEM associated with dengue virus (DENV‑ADEM) occurs later in course of the disease.

Hemorrhagic ADEM or AHEM is a rare entity forming around 2% of ADEM cases. Cases of SARS‑CoV‑2–associated AHEM have been reported in adults previously and this is the second reported case of hemorrhagic ADEM in India.

Authors conclude-"Although our patient showed good initial response to immunoglobulin and pulse steroids, further deterioration probably warranted early escalation of combination of immunotherapy.

Source:Journal of Pediatric Critical Care

MISCPIMS-TScovid-19 infectionIVIGJournal of pediatric critical care
Source : Journal of pediatric critical care
dr anusha
dr anusha

    MBBS, M.D. Pediatrics

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

    Show Full Article
    Next Story

    Editorial

    Aspirin Use in Male Smokers Aged 40-45 Years with Hypertension: Identifying the Ideal Candidates

    Aspirin Use in Male Smokers Aged 40-45 Years with Hypertension: Identifying the Ideal Candidates

    National Consensus 2025 on Role of Bisoprolol Across CV Continuum in Women: Top 10 Takeaways

    National Consensus 2025 on Role of Bisoprolol Across CV Continuum in Women: Top 10 Takeaways

    Relevance of Pioglitazone in Indian T2DM Care Continuum

    Relevance of Pioglitazone in Indian T2DM Care Continuum

    Azmarda Outperforms Generic Sacubitril/Valsartan in HFrEF Management, says new study

    Azmarda Outperforms Generic Sacubitril/Valsartan in HFrEF Management, says new study

    First Indian Consensus on Managing Refractory Gastroesophageal Reflux Disease Recommends Vonoprazan

    First Indian Consensus on Managing Refractory Gastroesophageal Reflux Disease Recommends Vonoprazan

    View All

    Journal Club Today

    Global Omega-3 Shortage Poses Serious Health and Environmental Risks: Study

    Global Omega-3 Shortage Poses Serious Health and Environmental Risks: Study

    View All

    Health News Today

    Health Bulletin 31/May/2025

    Health Bulletin 31/May/2025

    View All
    © 2022 All Rights Reserved.
    Powered By: Hocalwire
    X
    We use cookies for analytics, advertising and to improve our site. You agree to our use of cookies by continuing to use our site. To know more, see our Cookie Policy and Cookie Settings.Ok