These Rare Symptoms in Children With COVID-19 May Result in Serious Misdiagnosis

These rare but potentially life-threatening symptoms with COVID-19 are often missed in a diagnosis. Early identification is essential.
Larynx x-ray anatomy blue (CLIPAREA l Custom media/Shutterstock)
By Yuhong Dong, M.D., Ph.D.
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As of May 11, 2023, nearly 15.6 million cases of SARS-CoV-2 infection had been reported in children in the United States. Children represented almost 18 percent of all U.S. COVID-19 cases. The overall rate of infection was estimated to be 20,718 cases per 100,000 children. 
Although severe forms of COVID-19 are generally rare in children, studies have shown that in children infected with the virus, a significant number experience injuries to the brain and the nerves, including headache, seizure, peripheral neuropathy, stroke, demyelinating disorders, and encephalopathy.
However, there is still a rare but severe form of neurological injury in children. Though it has a variety of initial symptoms, including the inability to speak, breathe, or swallow well, they could all be related to vocal cord issues. Since these issues can potentially result in life-threatening consequences or outcomes, it’s important to identify the potential causes so that we can prevent or treat them as early as possible.

14-Year-Old Girl Unable to Breathe or Speak Well

The case of a 14-year-old girl who was sick with COVID-19 was reported in 2021 in the journal Pediatrics. About a week after she became sick, she started having noisy breathing (known as stridor), trouble with her voice and throat, pain in her chest, shoulders, and back, and a general feeling of weakness. When doctors examined her, they found a problem with one of the nerves in her head (the tenth cranial nerve) that affected her voice and breathing. They gave her medicine to reduce inflammation, but her condition got worse. She felt more pain, had numbness in her face, and became tired easily.

Because she was having a hard time breathing, doctors had to put a tube into her throat to help her breathe. They did an MRI scan and found that several nerves in her head were abnormal. Tests of her spinal fluid were okay, but a swab test confirmed she still had COVID-19. She was treated with special immune medicines and continued with the anti-inflammatory medication. Thankfully, she got better and was able to leave the hospital after nine days.

This case is unusual because it started with breathing difficulties and affected several nerves in her head, showing that COVID-19 can cause different nerve problems in young people. Although it looked a bit like another nerve disease called Guillain-Barré syndrome, the exact diagnosis was unclear, and it seemed more likely to be a unique kind of nerve injury caused by COVID-19.

15-Year-Old Girl Unable to Breathe or Swallow

In 2024, a similar case was reported in the journal Pediatrics that lasted longer. A 15-year-old girl with a history of asthma and anxiety had trouble breathing 13 days after testing positive for COVID-19. Two weeks prior to these symptoms, she had a stuffy nose and fever and was extremely tired, prompting COVID-19 testing. The test was positive, and her acute symptoms improved in five days. However, her breathlessness worsened over the next nine days, especially when active, leading her back to the emergency department, where she tested negative for other viruses, and asthma treatments did not help.

Ear, nose, and throat specialists found a problem with her vocal cords, so she was sent to speech therapy. But her breathing didn’t improve, and she developed new symptoms such as difficulty swallowing, weakness, tingling sensations, and trouble walking. She was then admitted for extensive testing by various specialists.

The tests, including MRIs and nerve exams, showed a syrinx in her spine but didn’t link it to her symptoms. A syrinx is a fluid-filled cyst that develops within the spinal cord. Her vocal cord issue and other symptoms were thought to be related to her COVID-19 infection. Attempts to treat her with medication didn’t work, leading to a tracheostomy surgery for breathing, a procedure that creates an opening in the front of the neck and into the trachea. This procedure helped, but she still needed it 13 months later. Her weakness and tingling resolved, possibly due to the temporary effects of COVID-19 or stress from her breathing problems.

This girl experienced paralysis of both vocal cords, which appears to have been a delayed result of her SARS-CoV-2 infection, according to her doctors. Despite thorough testing, no cause for her vocal cord paralysis was found. The nerve damage continued for 13 months, indicating that nerve issues in children following SARS-CoV-2 infection could be long-term.

Virus Spreads Regardless of Its Origin

The proliferation of the virus appears indifferent to its point of origin. Currently, no information is available regarding the vaccination status of the individuals involved. It is conceivable that our discerning readers might raise concerns, positing that the discourse surrounding the COVID-19 infections of the two girls mentioned above lacks a balanced consideration of the potential influence of vaccination.

A prevailing sentiment exists among certain individuals who assert that SARS-CoV-2 underwent manipulation within the confines of the Wuhan laboratory, with deliberate release purportedly instigating a global pandemic. Allegations extend to motives of control, depopulation, and financial enrichment for vaccine manufacturers, with skepticism directed toward the perceived role of vaccines in this overarching narrative.

An alternate viewpoint suggests a plausible correlation between the COVID-19 virus and genetic engineering within human laboratories. This theory suggests that manipulations aiming to enhance the adaptability of the original bat-derived coronavirus for human transmission may have occurred. The resultant gain-of-function would enable the virus to infiltrate human cells more effectively.
The SARS-CoV-2 virus, boasting an extensive genome of 30,000 nucleotides, raises concerns about the potential ramifications of human intervention in laboratory settings. Even if only a fraction of the genome undergoes engineered alterations, the fundamental biological behavior of the virus may remain unchanged. Consequently, the virus could persist in its ability to replicate and propagate within the population, contributing to significant infections.
A fitting analogy to this scenario involves replacing a segment of a large cake with fruit to add color. Despite this modification, the essence of the cake remains unchanged, drawing parallels to the potentially engineered components of the virus not fundamentally altering its biological behavior.

Common COVID-19 Nerve Injuries

The cause of these two cases is likely due to nerve injuries following COVID-19 infection. We may still remember that as early as 2021, about one-third of hospitalized COVID-19 patients reported at least one taste or olfactory disorder.
The COVID-19 virus has been shown to affect the nerves in the brain, spinal cord, and other parts of our body.
The nerves in the head most often affected by COVID-19 include the seventh, sixth, and third cranial nerves. Impairment of these nerves can lead to symptoms such as a partial or complete loss of taste, facial weakness or paralysis, and difficulty moving the eyes. Injuries in the tenth nerve are rare, as seen in the two cases reported above.
A 2021 review of the neurological conditions seen in the context of COVID-19 found that headache, altered mental status, and weakness were the most commonly reported neurological symptoms of COVID-19 infection in children. Other severe conditions include demyelinating disease, featured by the coating layer of the nerves being stripped off, stroke, and brain diseases.
A cross-sectional study of children two months to less than 18 years of age with COVID-19 from 52 children’s hospitals was conducted from March 2020 to March 2022. Of the 15,137 children hospitalized with COVID-19, 7.0 percent had a neurologic complication. Among them, the most frequent complications were seizures with or without a fever (6.2 percent) and brain disease (2.2 percent).
Vocal cord illnesses can occur in patients with mild COVID-19 symptoms.
For example, an 18-year-old girl who previously had vocal cord issues, such as muscle tension, chronic throat inflammation, and nodules on her vocal cords, experienced vocal cord paralysis at the same time she started showing mild symptoms of COVID-19. She was not hospitalized or put on a ventilator. After a CT scan ruled out other possible causes, doctors diagnosed her with COVID-19-related vocal cord paralysis.

How the Virus Damages Our Nerves

How can COVID-19 cause brain and nerve problems? There are a number of potential mechanisms of neurologic injury following SARS-CoV-2 infection, including direct viral injury to neural cells, vascular endothelial injury, autoimmunity, and inflammatory injury. 

The virus can directly invade our brain system via the olfactory nerve path, or it can cross the blood-brain barrier when carried by blood cells, creating a Trojan horse type of mechanism, allowing it to spread to the peripheral brain nerves that also control the vocal cords.

The virus may directly kill neuronal progenitor cells, which results in associated central neurons and peripheral nerves, including those controlling the throat and vocal cord. 
The virus attacks the inner lining of blood vessels of the brain, leading to blood clots and causing a lack of oxygen supply, resulting in nerve damage in the brain region responsible for the vocal cords.
COVID-19 can cause nervous system inflammation, injuring our healthy nerve cells. Inflammation caused by the infection in the lungs or throughout the body could also lead to brain and nerve issues.
After contracting the infection, the body’s immune response to the virus could mistakenly attack the nervous system, including the outer protective layer of nerves (myelin), which functions similarly to the insulation on electrical wires. Once myelin is destroyed, our nerves can no longer transmit neuronal signals quickly. That may explain why we think, respond, and move more slowly.

Similar Adult Cases

A review in 2022 reported that neurologic complications occurred in 14 to 57 percent of hospitalized adult patients with COVID-19. Unfortunately, their vaccination status was again not taken into consideration.
In rare instances, adults with COVID-19 have shown either one-sided or both-sided weakness or paralysis in their vocal cords. Peripheral nerve injury is often the main reason for vocal cord issues.
Some cases have required the long-term use of a tube inserted into a patient’s throat. For example, a 75-year-old woman with high blood pressure was hospitalized with COVID-19. After improving and being taken off a ventilator, she developed paralysis in her vocal cord nerves, causing hoarseness and swallowing difficulties.
Ventilator management is often linked to recognized complications, with one notable issue being recurrent laryngeal nerve palsy. This uncommon paralysis typically stems from damage caused by pressure, either through compression of the intubation tube or neck extension. It usually manifests as a unilateral condition, presenting immediately after extubation, and tends to show early improvement.

Even more rarely, patients with COVID-19 who didn’t need such a tube have also experienced vocal cord issues, suggesting that these problems could be caused by the virus itself and not due to the tube.

For example, a systematic COVID-19 case review included 16 adults with either vocal cord weakness or paralysis who didn’t require a breathing tube. The average age was 50, ranging from 28 to 72 years. Only two of them had vocal cord problems, and these were cases of weakness, not complete paralysis. None of them had severe breathing problems or needed airway surgery.

How to Better Protect Ourselves

Given the prevalence of COVID-19, doctors should consider the possibility of vocal cord problems in the diagnosis of children who have issues with their voice, swallowing, or breathing, even after a mild COVID-19 infection.

Breathing problems after recently having COVID-19 can be mistaken for more common issues like an asthma attack. If a patient’s condition doesn’t improve with usual treatments, it’s advisable to have an ear, nose, and throat specialist do a throat exam.

Many patients suffering from COVID-19-related vocal cord issues have chronic disease histories such as asthma, hypertension, throat issues, or mental health problems, such as anxiety.

Maintaining a healthy lifestyle will reduce the risk of contracting COVID-19. Eating well, exercising often, and getting enough sleep can help strengthen our immunity and reduce potential health problems.
When we’re dealing with specific health issues, it’s essential to be proactive by considering preventive ways to enhance our immunity, such as meditation, slow walking, or forest bathing, as they can holistically boost our health.
Early and adequate production of interferons and functional SARS-CoV-2-specific T cells play an essential role in strengthening our immune function and ability to fight and clear the COVID-19 virus effectively.
Studies have shown that improving our psychological well-being, such as maintaining compassion, may strengthen our immune system, enabling a more rapid and robust response to fight the virus. A healthy mindset may also help prevent severe COVID-19 while reducing our chances of contracting the virus.
Views expressed in this article are the opinions of the author and do not necessarily reflect the views of The Epoch Times. Epoch Health welcomes professional discussion and friendly debate. To submit an opinion piece, please follow these guidelines and submit through our form here.
Yuhong Dong
M.D., Ph.D.
Dr. Yuhong Dong, The Epoch Times’ senior medical columnist, is an award-winning senior medical scientific expert in infectious disease and neuroscience who is currently dedicated to researching solid modern scientific evidence of the profound connection between the mind, body, and spirit at the cellular, genetic, and systemic levels.
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