Acute cerebral infarction due to severe COVID-19, bacterial meningitis due to Pseudomonas stutzeri, mild loculated pericardial effusion due to MIS-C

Neurological involvement was common in children and adolescents with Coronavirus disease-2019 (COVID-19) related hospitalization and is mostly transient. A spectrum of life-threatening neurologic involvement infrequently occurred and was associated with more extreme inflammation and severe sequel. We reported a patient male, seven months old with chief complaint of fever since 1 month before admission. The patient was diagnosed by confirmed case COVID-19 with a positive RT-PCR SARS-CoV-2 swab. He had some contact with his parents that had confirmed with COVID-19 before. The patient also complained with focal seizures in the left extremity with decreased of consciousness. The seizure always repeated every day for 1 week with the same pattern. Patient also complain of nausea and vomiting every time he has been breastfed. There is no changes of the lips and oral cavity, no cutaneous rash, no red eyes, no swelling or edema on extremities. Non-contrast head CT-Scan revealed large area of acute cerebral infarction. Echocardiography revealed mild loculated pericardial effusion and cerebrospinal fluid cultured result revealed Pseudomonas stutzeri. After 3 weeks discharged from the hospital, the patient underwent a head MRI examination and the results revealed chronic ischemic cerebral infarction and communicating hydrocephalus. The patient was planned to undergo a VP shunt as a treatment for hydrocephalus. The neurological involvement can occur in children and adolescents with COVID-19. The range of severe neurologic complications including peripheral nerve disorders, focal CNS disease and diffuse CNS involvement, make it likely that multiple mechanisms underlie this wide spectrum of disease.