Post-COVID-19 acute disseminated encephalomyelitis: Case report and review of the literature

BACKGROUND: Our understanding of the spectrum of neurological manifestations associated with COVID-19 keeps evolving. Reports of life-threatening neurological complications, such as acute disseminated encephalomyelitis (ADEM), are alarmingly growing in number. CASE PRESENTATION: We report a 42 years old previously healthy man who presented with left visual loss and cognition deterioration, manifesting at least ten days after infection with SARS-CoV-2. Serological work-up for potential immunological markers (i.e., antibodies against aquaporin-4 and myelin oligodendrocyte glycoprotein) were negative. Magnetic resonance imaging revealed multiple bilateral and asymmetrical lesions in the brainstem, cortical, juxtacortical, and periventricular regions, with surrounding edema. Post-contrast sequences demonstrated punctate, ring, and open ring enhancement patterns. Methylprednisolone pulse therapy was initiated for the patient, and he was placed on rituximab. After one month, his clinical symptoms had resolved, and his cognitive function was normal. CONCLUSIONS: We conducted an extensive literature search, and COVID-19-associated ADEM cases reported thus far were identified and reviewed. ADEM often occurs in a post-infectious fashion; however, it is unclear how SARS-CoV-2 infection can trigger such rapidly progressive episodes of encephalopathy and demyelination. Nevertheless, considering the alarming number of cases of ADEM developing after SARS-CoV-2 infection, neurologists should consider this severe phenotype of COVID-19 neurological complication in mind, enabling prompt therapeutic interventions to be made.