Breakthrough SARS-CoV-2 infection precipitating a stroke in a child

A six-and-a-half-year-old fully vaccinated and previously healthy Asian boy presented to the accident and emergency department with 5-day history of high-grade fever associated with non-projectile vomiting, loose stools, abdominal pain, generalized rashes and conjunctivitis without discharge, reduced oral intake and urine frequency. However, he had no history of cough, joint or limb pain, sore throat or rhinorrhea. He was treated for a suspected bacterial infection with co-amoxiclav and paracetamol then cefixime, ibuprofen and desloratadine. As the illness progressed, he became extremely weak associated with headache and on the day of presentation at the hospital he was irritable, had lost speech with mouth deviation towards the left side. He had no reported convulsions, visual disturbance, difficulty swallowing, drooling, difficulty breathing or incontinence. A week prior to his illness, he was exposed to a relative suffering from COVID-19. 


A brain MRI revealed acute ischemic infarct along the territory of left middle cerebral artery involving caudate nucleus, putamen, insular cortex, and left parietal lobe. Gene X-pert on the sputum was negative for mycobacterium tuberculosis, nasopharyngeal swab for COVID-19 PCR was also negative (but later found positive for COVID-19 IgG antibody) and sickle cell scan test showed HbA.

During the hospital stay, no adverse or unanticipated events occurred in the child, and he improved clinically with time. He was treated and discharged on the fourth day post admission on IV ceftriaxone and IV acyclovir to complete 7 and 14 days respectively. On follow-up, 2 days later, he was able to communicate using single words, walk with support with right leg still dragging. He was seen again 2 weeks later in the outpatient setting and was able to communicate in sentences, ambulant with dragging of right leg and power of 4/5 in upper and lower limbs of right side with brisk deep tendon reflexes and was advised to continue with physiotherapy and occupational therapy.


REFERENCES

Osman RS, Dawood SS, Thawer SP, Mandania SM, Amirali MH, Bulimba MN, Walli NZ, Kija EN, Manji HK. SARS-CoV-2 precipitating a stroke in a child? A case report from Tanzania. Pan Afr Med J. 2022 May 12;42:33. doi: 10.11604/pamj.2022.42.33.33018. PMID: 35910064; PMCID: PMC9288122.

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