Page 353 - Abstract Book KONIKA 18

Neurology

P-NEU-033
Plasma Exchange for the Treatment of Transverse Myelitis
Unresponsive to Steroid: A Case Report

Rahman Setiawan, Raden Muhammad Indra, Masayu Rita Dewi
Department of Child Health, Faculty of Medicine Universitas Sriwijaya/Dr. Mohammad Hoesin General Hospital
Palembang, South Sumatera, Indonesia

Abstract
Background Steroid-resistant transverse myelitis is an inflammation of the spinal cord that is unresponsive
to steroid therapy. Plasma exchange can be beneficial for this condition. Objective To report the first case of
steroid-resistant transverse myelitis in Palembang that received plasma exchange due to steroid resistance.
Case A 17-year-old girl was admitted with weakness of both lower extremities that started a month before
admission. Urinary and anal incontinences were present. There was no history of trauma and no impairment
of consciousness. Examination of lower extremities showed reduced muscle strength of 1/1, decreased tone
and tendon reflexes on both limbs. Spinal MRI revealed abnormal signal intensity at T2-T11 with contrast
enhancement, compatible with transverse myelitis. Nerve conductions were normal. She received initial
therapy with high dose methylprednisolone (30 mg/kg/day), which did not improve. Plasma exchange was
then performed, consisted of five cycles. Neurological function improved with increased muscle strength
(lower extremities 3/3) and reduced incontinences. Conclusion Plasma exchange can be an effective treatment
for steroid-resistant transverse myelitis.
Keywords: steroid-resistant transverse myelitis; plasma exchange

P-NEU-034
SARS-CoV-2-associated Guillain-Barre Syndrome in a 20-month-old infant:
A Case Report

Rahmi Lestari, Indra Ihsan, Finny Fitry Yani
Department of Child Health, Faculty of Medicine, Universitas Andalas/Dr. M. Djamil Hospital,
Padang, West Sumatera, Indonesia

Abstract
Background Guillain-Barre Syndrome (GBS) is among the important neurological manifestations and
complications of coronavirus disease 2019 (COVID-19). However, GBS in children under 2 years is
rare, and as far as we know has never been reported in the context of severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) infection. Objective To demonstrate excellent outcome despite severe GBS
in a 20 months old infant with positive SARS-CoV-2 antibody. Case A 20-month-old infant was presented
to our emergency department with symmetric, progressive, ascending flaccid quadriparesis that developed
36 hours before admission. There was a history of fever and cough in the previous week. No alteration in
sensorium nor abnormality in cranial nerves was found. Lumbar puncture was performed immediately and
revealed albuminocytologic dissociation. Shortly, his condition deteriorated with poor respiratory effort and
secretion control. He was sent to intensive care unit for ventilatory support, and intravenous immunoglobulin
was initiated with total dose of 2 g/kg body weight. His neurology examination improved gradually in the
next following days. Nerve conduction study was compatible with axonal neuropathy feature of GBS. Result
of SARS-CoV-2 nucleic acid amplification was negative. However the diagnosis of prior infection was
confirmed by positive IgG antibody. He gained full recovery within 3 weeks. Conclusion Post-infectious
autoimmune process seems to be the underlying mechanisme responsible for GBS secondary to Covid-19
infection in children, and responds well to immunotherapy.
Keywords: Guillain-Barre syndrome; SARS-CoV-2; COVID-19; infant

KONIKA XVIII Abstract Book 305