{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:07:13Z","timestamp":1787162833384,"version":"build-2736575974"},"reference-count":4,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2021,4,1]],"date-time":"2021-04-01T00:00:00Z","timestamp":1617235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,5,17]]},"abstract":"<jats:p>COVID-19 pandemic is increasingly being recognized in infants and some develop cytokine storm mediated tissue damage. We report 5-month-old infant presenting with fever, refusal of feeds, developing altered sensorium and convulsions during the hospital course, tested positive for SARS-CoV2 RT-PCR in second week of illness. Her serology was also Dengue positive. She had features of cytokine storm and her MRI Brain suggested acute demyelinating encephalomyelitis (ADEM). She was treated with high-dose methylprednisolone followed oral prednisolone, under antibiotics cover. Infant improved gradually over 3\u2009weeks duration following a stormy hospital course. On follow-up, infant showed delayed motor milestones with epileptic spasms and hysparrhthymia on EEG, progressing to develop secondary West syndrome. Features of acute encephalopathy, hypercytokinemia and restricted diffusion on DWI\u2013MRI, with post-encephalopathic epilepsy, pointed to a differential of ADEM\u2014acute leukoencephalopathy with restricted diffusion (ALERD) as the primary diagnosis; establishing ALERD as a possible neurological complication of COVID-19 infection in infants.<\/jats:p>","DOI":"10.1093\/tropej\/fmab026","type":"journal-article","created":{"date-parts":[[2021,4,14]],"date-time":"2021-04-14T20:27:06Z","timestamp":1618432026000},"source":"Crossref","is-referenced-by-count":8,"title":["Acute Leukoencephalopathy with Restricted Diffusion in an Infant with Severe COVID-19 and Dengue Coinfection Progressing to West Syndrome"],"prefix":"10.1093","volume":"67","author":[{"given":"Mallesh","family":"Kariyappa","sequence":"first","affiliation":[{"name":"Department of Paediatrics, Bangalore Medical College & Research Institute, Bengaluru, Karnataka 560002, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varun","family":"Govindarajan","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Bangalore Medical College & Research Institute, Bengaluru, Karnataka 560002, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anitha","family":"Kommalur","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Bangalore Medical College & Research Institute, Bengaluru, Karnataka 560002, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,5,17]]},"reference":[{"key":"2021120509200513400_fmab026-B1","doi-asserted-by":"crossref","first-page":"1446","DOI":"10.3389\/fimmu.2020.01446","article-title":"The COVID-19 cytokine storm; what we know so far","volume":"11","author":"Ragab","year":"2020","journal-title":"Front Immunol"},{"key":"2021120509200513400_fmab026-B2","doi-asserted-by":"crossref","first-page":"519","DOI":"10.4103\/ijccm.IJCCM_139_18","article-title":"Acute leukoencephalopathy with restricted diffusion","volume":"22","author":"Kamate","year":"2018","journal-title":"Indian J Crit Care Med"},{"key":"2021120509200513400_fmab026-B3","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1016\/S1474-4422(20)30221-0","article-title":"Neurological associations of COVID-19","volume":"19","author":"Ellul","year":"2020","journal-title":"Lancet Neurol"},{"key":"2021120509200513400_fmab026-B4","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1002\/jmv.26269","article-title":"Coinfection, coepidemics of COVID-19, and dengue in dengue- endemic countries: a serious health concern","volume":"93","author":"Miah","year":"2021","journal-title":"J Med Virol"}],"container-title":["Journal of Tropical Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/tropej\/article-pdf\/67\/2\/fmab026\/41508806\/fmab026.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/tropej\/article-pdf\/67\/2\/fmab026\/41508806\/fmab026.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,5]],"date-time":"2021-12-05T04:20:48Z","timestamp":1638678048000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/tropej\/article\/doi\/10.1093\/tropej\/fmab026\/6276662"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,1]]},"references-count":4,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,5,17]]}},"URL":"https:\/\/doi.org\/10.1093\/tropej\/fmab026","relation":{},"ISSN":["0142-6338","1465-3664"],"issn-type":[{"value":"0142-6338","type":"print"},{"value":"1465-3664","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,4,1]]},"published":{"date-parts":[[2021,4,1]]},"article-number":"fmab026"}}