Acute disseminated encephalomyelitis (ADEM) is an acute demyelinating disorder of the central nervous system that is ordinarily monophasic. ADEM can develop following infection or vaccination. Here, we present a 37 y/o male patient with progressive muscle weakness in all limbs along with dysphagia following COVID-19 vaccination. Brain magnetic resonance imaging (MRI) revealed typical imaging findings which presented as multifocal T2-FLAIR signal changes in the corticospinal tract, pons, and temporal lobe with diffusion restriction. Magnetic resonance spectroscopy (MRS) further confirmed the diagnosis by the typical elevation of the Choline and Myoinositol peaks. Neurologic impairments have been reported as the potential side effects of COVID-19 vaccines. Appropriate imaging modalities together with a thorough clinical examination are essential for making a correct diagnosis.

Kawasaki‐like disease (KLD) and multisystem inflammatory syndrome in children (MIS‐C) are considered as challenges for pediatric patients under the age of 18 infected with coronavirus disease 2019 (COVID‐19). A systematic search was performed on July 2, 2020, and updated on December 1, 2020, to identify studies on KLD/MIS‐C associated with COVID‐19. The databases of Scopus, PubMed, Web of Science, Embase, and Scholar were searched. The hospitalized children with a presentation of Kawasaki disease (KD), KLD, MIS‐C, or inflammatory shock syndromes were included. A total number of 133 children in 45 studies were reviewed. A total of 74 (55.6%) cases had been admitted to pediatric intensive care units (PICUs). Also, 49 (36.8%) patients had required respiratory support, of whom 31 (23.3%) cases had required mechanical ventilation/intubation, 18 (13.5%) cases had required other oxygen therapies. In total, 79 (59.4%) cases had been discharged from hospitals, 3 (2.2%) had been readmitted, 9 (6.7%) had been hospitalized at the time of the study, and 9 (6.7%) patients had expired due to the severe heart failure, shock, brain infarction. Similar outcomes had not been reported in other patients. Approximately two‐thirds of the children with KLD associated with COVID‐19 had been admitted to PICUs, around one‐fourth of them had required mechanical ventilation/intubation, and even some of them had been required readmissions. Therefore, physicians are strongly recommended to monitor children that present with the characteristics of KD during the pandemic as they can be the dominant manifestations in children with COVID‐19.

We reviewed the reported imaging findings of myocarditis in the literature following COVID-19 vaccination on cardiac imaging by a literature search in online databases, including Scopus, Medline (PubMed), Web of Science, Embase (Elsevier), and Google Scholar. In total, 532 cases of myocarditis after COVID-19 vaccination were reported (462, 86.8% men and 70, 13.2% women, age range 12 to 80) with the following distribution: Pfizer-BioNTech: 367 (69%), Moderna: 137 (25.8%), AstraZeneca: 12 (2.3%), Janssen/Johnson & Johnson: 6 (1.1%), COVAXIN: 1 (0.1%), and unknown mRNA vaccine: 9 (1.7%). The distribution of patients receiving vaccine dosage was investigated. On cardiac MR Imaging, late intravenous gadolinium enhancement (LGE) was observed mainly in the epicardial/subepicardial segments (90.8%, 318 of 350 enhancing segments), with the dominance of inferolateral segment and inferior walls. Pericardial effusion was reported in 13.1% of cases. The vast majority of patients (94%, 500 of 532) were discharged from the hospital except for 4 (0.7%) cases. Post-COVID-19 myocarditis was most commonly reported in symptomatic men after the second or third dose, with CMRI findings including LGE in 90.8% of inferior and inferolateral epicardial/subepicardial segments. Most cases were self-limited.

To the editor, Among the advancement of the COVID-19 pandemic, the pathogenic virus proceeds to change genomic epidemiology and steadily whole-genome sequencing evolution. One of the latest variations, SARS-CoV-2 delta, B.1.617.2 variant of concern (VOC) formerly, has become the most prevalent type of SARS-CoV-2 in many countries [1]. It identified following an upsurge in the western part of India since January 2021. More detailed analysis disclosed that the prevailing lineage in distribution is a novel identified lineage B.1.617 holding in common signature mutations D111D, G142D, L452R, E484Q, D614G, and P681R, in the spike protein, containing within the receptor-binding domain (RBD) [2, 3]. Following the initial high mortality rate of this variation in India as its hostess, as the growing number of fatal reports from several countries regarding its transfer to most parts of world in recent months, Delta variation was known as the deadliest COVID-19 [4, 5, 6]. According to official statistics, the mortality rate in individuals in areas where the Delta variant has become dominant is much higher than the same period and the epidemic with previous COVID-19 lineages. The enigma here is, does this mean more lethality of this variant?