Page 341 - Abstract Book KONIKA 18

Neurology

P-NEU-009
COVID-19-related Multisystem Inflammatory Syndrome in Children
causing Optic Neuritis and Acute Glomerulonephritis

Dina Marselina, Amanda R. Soebadi, Henny A. Puspitasari
Department of Child Health, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital,
Jakarta, Indonesia

Abstract
Background Coronavirus disease 19 (COVID-19) in children develops wide range of manifestations
from asymptomatic to a severe multisystem inflammatory syndrome in children (MIS-C). Current data
regarding neuro-ophthalmological manifestations in pediatric patients with COVID-19 are still scarce.
Objective To demonstrate a case of MIS-C with concomitant optic neuritis and acute glomerulonephritis.
Case A 11-year-old-previously healthy boy was referred to our hospital with blurry vision since 10 days
prior to admission. He had history of fever, headache, vomiting, and focal seizure followed by a secondary
generalized seizure. There was no history of trauma. His neurological examination results were normal
except his visual acuity was 3/60 and 3/60. There was no focal neurological deficit and his general physical
examination was unremarkable. All laboratory and radiological findings were unremarkable, except for
reactive SARS-CoV-2 antibodies. Visual evoked potential results confirmed bilateral demyelinating lesion
of the optic nerve. Further diagnostic evaluation was nonsuggestive of multiple sclerosis with negative
cerebrospinal fluid anti-aquaporine-4 and oligoclonal bands. The disease course was complicated by acute
glomerulonephritis manifested with hypertension, gross hematuria, normal ASTO and complement. There was
elevated WBC count with left shift and lymphopenia, increased D-dimer and fibrinogen. The MIS-C with eye
and kidney involvement was made, and treated with a 5-day course of 10 mg/kg/day methylprednisolone as
well as low molecular weight heparin, followed by intravenous immunoglobulin. Vision returned to normal
on day 10 of admission and remained normal on follow-up visits.
Keywords: optic neuriti; acute glomerulonephritis; MIS-C; COVID-19

P-NEU-010
The Challenging in Diagnosis and Treatment of Anti-N-Methyl-D-Aspartate
Receptor Encephalitis: A Case Series at a Tertiary Care Hospital in Yogyakarta
Denny Wellyam Sigarlaki, Agung Triono, ES Herini, Sunartini
Departement of Child Health, Dr Sardjito General Hospital, Faculty of Medicine Universitas Gadjah Mada,
Yogyakarta, Central Java, Indonesia
Abstract
Background Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is formidable disease with
great variation in clinical presentation and response to treatment. The spectrum of non-specific symptoms
can lead to misdiagnosis with improperly selected therapy and sequelae for patients. Objective To provide a
detailed account of the common presenting sign and symptoms, and response to standart protocol in children
with anti-NMDAR encephalitis. Cases We present four cases fulfilled criteria for probable anti-NMDAR
encephalitis, three patients were confirmed anti-NMDAR encephalitis. One patient confirmed from serum
examination for anti-NMDAR, while two patients from cerebrospinal fluid. All cases presented with fever
and revealed chorea as movement disorder and speech disorder. Electroencephalography of three patients
who had a seizure in early phase showed epileptiform discharge, none had delta brush. Brain imaging
showed high signal intensity in ganglia basalis in two cases, brain atrophy in one case, and no abnormality
in one case. The modified Rankin Score (mRS) was 5 in two cases and 4 in the other cases. One case
received intravenous immunoglobulin plus MP (high dose methylprednisolone), one case plasma exchange
plus MP, whilst the last two cases only had MP as firstline therapy. All cases received cyclophosphamide
as a secondline therapy. At follow-up, two cases reached mRS of 1, one case of 2, and one case of 4.
Conclusion Careful understanding of the clinical features of the disease, diagnosis, and treatment option
may improve the care of these complex case.
Keywords: Anti-NMDA; autoimmune encephalitis; immunotherapy; chorea

KONIKA XVIII Abstract Book 293