Anti–SARS-CoV-2 and Autoantibody Profiles in the Cerebrospinal Fluid of 3 Teenaged Patients With COVID-19 and Subacute Neuropsychiatric Symptoms

IMPORTANCE: Neuropsychiatric manifestations of COVID-19 have been reported in the pediatric population. OBJECTIVE: To determine whether anti–SARS-CoV-2 and autoreactive antibodies are present in the cerebrospinal fluid (CSF) of pediatric patients with COVID-19 and subacute neuropsychiatric dysfunction. DESIGN, SETTING, AND PARTICIPANTS: This case series includes 3 patients with recent SARS-CoV-2 infection as confirmed by reverse transcriptase–polymerase chain reaction or IgG serology with recent exposure history who were hospitalized at the University of California, San Francisco Benioff Children’s Hospital and for whom a neurology consultation was requested over a 5-month period in 2020. During this period, 18 total children were hospitalized and tested positive for acute SARS-CoV-2 infection by reverse transcriptase–polymerase chain reaction or rapid antigen test. MAIN OUTCOMES AND MEASURES: Detection and characterization of CSF anti–SARS-CoV-2 IgG and antineural antibodies. RESULTS: Of 3 included teenaged patients, 2 patients had intrathecal anti–SARS-CoV-2 antibodies. CSF IgG from these 2 patients also indicated antineural autoantibodies on anatomic immunostaining. Autoantibodies targeting transcription factor 4 (TCF4) in 1 patient who appeared to have a robust response to immunotherapy were also validated. CONCLUSIONS AND RELEVANCE: Pediatric patients with COVID-19 and prominent subacute neuropsychiatric symptoms, ranging from severe anxiety to delusional psychosis, may have anti–SARS-CoV-2 and antineural antibodies in their CSF and may respond to immunotherapy.