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This is a case report of acute necrotizing encephalopathy and myocarditis in a 33-year-old previously healthy female infected with COVID-19. She progressed from generalized nonspecific viral symptoms to coma within 4 days and had generalized status epilepticus. Echocardiography and cardiac MRI demonstrated diffuse myocardial dyskinesia and pericarditis. MRI of the brain demonstrated bilateral thalamic hyperintensities, which were followed by bilateral thalamic and cerebellar hemorrhages 2 days later.
Providers must recognize early features of acute necrotizing encephalopathy related to SARS-Cov2.
– Kyle Binder, MD
This abstract is available on the publisher's site.
Neurologic complications from SARS-Cov2 infection are insufficiently understood.1 ANE has been described in children and adults after various acute viral respiratory infections, most notably influenza A (H1N1).2 Concomitant extrapulmonary manifestations includes myocarditis and pericarditis.3 Our patient had confirmed SARS-Cov2 infection and presented with features consistent with fulminant ANE and myocarditis in addition to hypoxemic respiratory failure from ARDS. We know of only 1 previously reported case of ANE associated with SARS-Cov2 infection,4 and myocarditis has been documented.5 The frequency of these complications is unclear. Necropsy was not performed in our patient, but her neuroradiologic findings were quite characteristic for the diagnosis of ANE. This diagnosis must be considered in patients with SARS-CoV-2infection presenting with or developing altered consciousness.