期刊
JAMA NEUROLOGY
卷 78, 期 12, 页码 1503-1509出版社
AMER MEDICAL ASSOC
DOI: 10.1001/jamaneurol.2021.3821
关键词
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资金
- S10 Shared Instrumentation grant [1S10OD017993-01A1]
- National Institute of Mental Health [R01MH122471]
- National Institute of Neurological Disorders and Stroke [K08NS096117, R01NS118995-14S]
- Brain Research Foundation
- Howard Hughes Medical Institute
- University of California, San Francisco
- Latinx Center of Excellence [D34HP3178]
Neuropsychiatric manifestations of COVID-19 have been reported in pediatric patients. This study found that pediatric patients with COVID-19 and subacute neuropsychiatric symptoms may have anti-SARS-CoV-2 and antineural antibodies in their cerebrospinal fluid, and may respond to immunotherapy.
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.
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