A case of acute ophthalmoplegia presenting after multisystem inflammatory syndrome in children (MIS-C)

Objectives: Multisystem inflammatory syndrome (MIS-C) is a new pediatric hyperinflammation disorder caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). We aimed to report a case with acute ophthalmoplegia presenting after MIS-C. Case Presentations: A 9-year-old girl was admitted to the pediatric emergency department with sudden onset double vision and headache. She was diagnosed with COVID-19 infection 5 weeks and was stay in the hospital 2 weeks ago due to MIS-C. She received methylprednisolone, intravenous immunoglobulin (IVIg), salicylic acid and antibiotics for MIS-C. On neurological examination, she had bilateral limitation of outward and upward gaze, and binocular horizontal diplopia. The remaining neurological examination was normal. Cerebrospinal fluid results were evaluated as normal. Cranial and orbital MRI, and MRI venography were unremarkable. ganglioside antibodies such as GM1, GQ1b, GD1a, GD1b, GT1b were negative. On the 7th day after IVIg treatment (total 1 g/kg, 2 day), a significant improvement was observed in the ophthalmoplegia. Conclusion: Miller-Fisher syndrome was previously described after COVID-19 infections, but to our knowledge this is the first report to describe acute ophthalmoplegia (without ataxia and areflexia) in a child after MIS-C.
Keywords: Acute ophthalmoplegia, COVID-19, MIS-C