A boy aged 15 years with acute disseminated encephalomyelitis (ADEM) found to have human coronavirus (HCoV) in the cerebrospinal fluid (CSF) and nasopharynx is reported from the Children’s Hospital of Buffalo, SUNY at Buffalo, NY. The child presented with a 5-day history of numbness that began in the lower extremities and progressed to the umbilicus. He had difficulty in walking, clumsiness in the right hand, and increased irritability. An upper respiratory infection had occurred one week before the onset of numbness, and the brother had recently recovered from a sore throat. The neurologic examination revealed normal optic discs and cranial nerves, mild distal weakness (4/5) in the right hand and foot, patchy loss of vibration and temperature sensation below T10, normal proprioception and pinprick sensation, negative Romberg test, mild dysmetria of the left hand, and an impaired tandem and antalgic gait. Symptoms resolved over several weeks without therapy. MRI of brain and spinal cord on admission showed lesions on T-2 weighted imaging at C4-C5 and T7-T8, and patchy hyperintensities in the white matter, especially the centrum semiovale and left cerebellum. Coronavirus OC43 was detected in CSF and nasopharyngeal secretions by PCR, and antibody titers rose from 1:160 in acute serum to 1:640 in convalescent serum at 3 weeks. Tests for other viruses were negative. CSF showed 10 red cells and 38 white blood cells, 92% lymphocytes, protein 40 mg/dL, and glucose 58 mg/dL. Immunoglobulin G index was 0.77 (normal <0.70). A test for oligoclonal bands was omitted. MRI at 6 weeks showed improvement, but follow-up MRI at 3 months revealed a new asymptomatic lesion in the left cerebellar hemisphere, and periventricular lesions in the right cerebral hemisphere were brighter and larger. ADEM was the presumed diagnosis, the first reported case associated with coronavirus in a child, but multiple sclerosis could not be ruled out. [1]

COMMENT. ADEM is a post- or para-infectious illness that is usually preceded by a febrile upper respiratory viral infection (URI) or vaccination, and follows a monophasic course with recovery in 90%. ADEM is distinguished from MS by long-term clinical follow-up, absence of relapsing course and new MRI lesions, and absent oligoclonal bands in the CSF (see Ped Neur Briefs Nov 2002;16:81-82, for commentary on long-term study of 84 children with ADEM). Coronavirus (HCoV), a common cause of URI, has not previously been associated with ADEM, although a chronic demyelinating disorder resembling MS occurs with HCoV infection in the mouse model. HCoV RNA has been demonstrated in the CSF and brain of MS patients, but also in autopsy specimens of controls without neurologic disease. The role of coronavirus in demyelinating disease is undetermined.