Report #2883269

Overview

Sex

Male

Age

1 yrs

State

PA

Recovered

Not recovered

Vaccinated

Jan 22, 2026

Onset

Jan 22, 2026

Days to onset

0

Hospital days

3

Symptoms (31)

Symptom narrative

Patient is a 12-month-old male, was admitted after multiple seizures following recent URI symptoms and vaccines (developed seizures shorty after). Found to have a positive SARS-CoV-2 test. 1/22: Initial labs showed negative rapid flu, RSV, and COVID-19, but positive SARS-CoV-2; urinalysis was negative for drugs except for benzodiazepines, attributed to medication administration. Patient is a 12 month male with no PMH presents with seizures after 12 month vaccines at PCP. For the last week, pt has had some URI sick symptoms although last fever was believed to be about Monday of this week (admission on Thursday 1/22). For his 12 month visit, he went to his routine PCP well child check, where he received his vaccines. He subsequently had 1 seizures at home. EMS was called and had 2 more seizures for which he was given versed. Mom believed that each of these seizures lasted 5-10 minutes although unsure of exact timing. Semiology was described as: stiffened up, then arms and legs started shaking, lips turned blue. He was brought to ED wherein physical exam was notable for ill-appearing and rocking back and forth, unable to sit still, coarse breath sounds, obstructing after seizures. During sign out of ED providers, patient had several recurrent seizure events w GTC movements and hypoxia, lasting about 1 minute each in succession. Given ativan x 2 and keppra load w ultimate sustained resolution of seizure activity, noted to intermittently move all extremities and cry appropriately; however, after subsequent dosing, persistent airway obstruction and lethargy in the setting of AEDs, ultimately intubated for airway protection successfully on 1st attempt without acute events. CT scan obtained en route to ICU. He was subsequently given CTX x1 and Vancomycin x1. Upon arrival to the ICU, patient was intubated and sedated. He was placed on EEG, for which Neurology Fellow contacted team regarding ongoing seizure activity, and suggested loading with valproic acid. Given degree of seizures and concern for change in mental status prior to intubation, team elected to proceed with lumbar puncture. Brief Hospital Course: Pt was admitted to the ICU from 1/22/26-1/24/26 and transferred to the neurology service 1/24/26 - 1/25/26 He was started on maintenance Keppra at 30mg/kg/day and Diastat rescue for seizures > 5 minutes. Work reassuring against acute bacterial CNS infection; completed on 48 hour rule out with ceftriaxone and vancomycin. MRI brain obtained and reassuring against structural cause or acute intracranial process. We most suspect viral meningitis given no clear fever as provoking factor for seizures and WBCs seen in CSF. On day of discharge, pt continued to have axial ataxia, though greatly improved. He was tolerating a regular diet well, VS normal. Plan for follow up with Neurology via telemedicine in 2-4 days, then 3/2/26 in person; and follow up with pediatrician in 3-5 days. . PT/OT referrals provided, if ataxia resolves in the next few days, as we expect it will, can defer these.

Current illness

Had URI symptoms 10 days prior to vaccination, febrile 4 days prior to vaccination. Found to have COVID+

Medical history

None

Other medications

Cholecalciferol

Allergies

No

Lab data

1/23: CSF analysis revealed elevated nucleated cells (12-22/uL), high lymphocytes (80-83%), and increased RBCs (725-1150/µl), consistent with viral meningitis; CSF protein and glucose were normal, and HSV PCR was negative. . CSF cultures remained negative after 48 hours, supporting a viral etiology. . MRI brain showed no acute intracranial abnormalities; EEG revealed diffuse cerebral dysfunction and eight subclinical seizures.