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This is a case report of COVID-19–related acute necrotizing encephalopathy. The patient presented with rapidly evolving encephalopathy in the context of COVID-19 pneumonia, and imaging revealed extensive necrotizing lesions. SARS-CoV-2 RNA was found in the CSF 19 days after symptom onset and after initial negative tests. Improvement was seen after treatment with IV immunoglobulins and plasma exchange.
This case highlights the potential neurotropism of the virus and the fact that SARS-CoV-2 RNA CSF positivity can occur with delay and after initial negative tests.
– Codrin I. Lungu, MD
This abstract is available on the publisher's site.
Here, we report a case of COVID-19-related acute necrotizing encephalopathy where SARS-CoV-2 RNA was found in CSF 19 days after symptom onset after testing negative twice. Although monocytes and protein levels in CSF were only marginally increased, and our patient never experienced a hyperinflammatory state, her neurologic function deteriorated into coma. MRI of the brain showed pathologic signal symmetrically in central thalami, subinsular regions, medial temporal lobes, and brain stem. Extremely high concentrations of the neuronal injury markers neurofilament light and tau, as well as an astrocytic activation marker, glial fibrillary acidic protein, were measured in CSF. Neuronal rescue proteins and other pathways were elevated in the in-depth proteomics analysis. The patient received IV immunoglobulins and plasma exchange. Her neurologic status improved, and she was extubated 4 weeks after symptom onset. This case report highlights the neurotropism of SARS-CoV-2 in selected patients and emphasizes the importance of repeated lumbar punctures and CSF analyses in patients with suspected COVID-19 and neurologic symptoms.
Acute Necrotizing Encephalopathy With SARS-CoV-2 RNA Confirmed in Cerebrospinal Fluid
Neurology 2020 Sep 08;95(10)445-449, J Virhammar, E Kumlien, D Fällmar, R Frithiof, S Jackmann, MK Sköld, M Kadir, J Frick, J Lindeberg, H Olivero-Reinius, M Ryttlefors, JL Cunningham, J Wikström, A Grabowska, K Bondeson, J Bergquist, H Zetterberg, E Rostami