Can plasma exchange therapy be an option for the treatment of SARS-CoV-2 Related Splenial Lesion Syndrome: Two cases from the pediatric intensive care unit

Reversible splenial lesion syndrome (RESLES) is characterized by a temporary lesion in the splenium of the corpus callosum. RESLES is one of the most common causes of Mild encephalitis/encephalopathy reversible splenial lesion (MERS) and a rare clinical syndrome for the pediatric population. In a li...

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Bibliographic Details
Published in:	Transfusion and apheresis science Vol. 61; no. 5; p. 103491
Main Authors:	Varol, Fatih, Ergul, Nese, Sahin, Ebru Guney, Can, Yasar Yusuf, Ergul, Umut, Guven, Sirin, Cam, Halit
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-10-2022
Subjects:	Brain Diseases - complications Brain Diseases - diagnosis Brain Diseases - therapy Case Report Child COVID-19 COVID-19 - therapy Humans Immunoglobulins, Intravenous - therapeutic use Intensive Care Units, Pediatric Methylprednisolone - therapeutic use Plasma Exchange RESLES SARS-CoV-2 Syndrome Therapeutic plasma exchange COVID-19 RESLES Therapeutic plasma exchange
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Summary:	Reversible splenial lesion syndrome (RESLES) is characterized by a temporary lesion in the splenium of the corpus callosum. RESLES is one of the most common causes of Mild encephalitis/encephalopathy reversible splenial lesion (MERS) and a rare clinical syndrome for the pediatric population. In a limited number of pediatric case reports, association with SARS-COV-2 in was reported. We aimed to increase the awareness of neurological involvement and treatment options of RESLES in children diagnosed with MIS-C. We report two cases with a diagnosis of multisystem inflammatory syndrome-children who developed RESLES during the disease course. Fever, blurred vision, ataxia and encephalopathy were the main central nervous system symptoms. In our first case, we observed a rapid recovery in clinical symptoms and complete resolution of the splenial lesion in with intravenous immunoglobulin (IVIG) and methylprednisolone treatment. However, our second case did not respond to IVIG and methylprednisolone treatment. We performed therapeutic plasma exchange therapy and observed a successful recovery both in brain magnetic resonance imaging and echocardiographic findings. Although IVIG and methylprednisolone are the first choice treatment methods in MIS-C cases progressing with RESLES, therapeutic plasma exchange may be an option for the treatment of unresponsive cases.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3 ORCID ID: 0000-0002-1767-1551 ORCID ID: 0000-0001-8459-2872 ORCID ID: 0000-0002-2665-5326 ORCID ID: 0000-0001-2680-2437 ORCID ID: 0000-0002-2424-6887 ORCID ID: 0000-0003-2090-9222 ORCID ID: 0000-0002-2611-9515
ISSN:	1473-0502 1878-1683 1473-0502
DOI:	10.1016/j.transci.2022.103491