2021-03-24

Neurology Department, University Hospitals of Cleveland, Cleveland, OH, USA.; Case Western Reserve University School of Medicine, Cleveland, OH, USA.; Neurology Department, University Hospitals of Cleveland, Cleveland, OH, USA.; Neurology Department, University Hospitals of Cleveland, Cleveland, OH, USA.; Neurology Department, University Hospitals of Cleveland, Cleveland, OH, USA.; Neurology Department, University Hospitals of Cleveland, Cleveland, OH, USA.; Neurology Department, University Hospitals of Cleveland, Cleveland, OH, USA.; Neurology Department, University Hospitals of Cleveland, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA.; Neurology Department, University Hospitals of Cleveland, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA.; Case Western Reserve University School of Medicine, Cleveland, OH, USA; Infectious disease department, University Hospitals of Cleveland, Cleveland, OH, USA.; Neurology Department, University Hospitals of Cleveland, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA; Multiple Sclerosis and Neuroimmunology Program, University Hospitals of Cleveland, Cleveland, OH, USA. Electronic address: hesham.abboud@uhhospitals.org.

BACKGROUND: Serious neurological complications of SARS-CoV-2 are increasingly being recognized. CASE: We report a novel case of HHV6 myelitis with parainfectious MOG-IgG in the setting of COVID-19-induced lymphopenia and hypogammaglobulinemia. The patient experienced complete neurological recovery with gancyclovir, high dose corticosteroids, and plasma exchange. To our knowledge, this is the first case of HHV6 reactivation in the central nervous system in the setting of COVID19 infection and the first case of MOG-IgG myelitis in the setting of SARS-CoV-2 and HHV6 coinfection. CONCLUSION: Patients with neurological manifestations in the setting of COVID19-related immunodeficiency should be tested for opportunistic infections including HHV6. Viral infection is a known trigger for MOG-IgG and therefore this antibody should be checked in patients with SARS-CoV-2 associated demyelination.CI - Copyright © 2021 Elsevier B.V. All rights reserved.