A Case of Acute Encephalitis in COVID-19 Patient: A Rare Complication

Abstract

Coronavirus disease 19 (COVID-19) is a respiratory disease, has a variable presentation, and neurological involvement in COVID-19 is not widely reported. We report a rare case of acute encephalitis in a COVID-19 patient presented with fever, dry cough, and dyspnea. She had a fever, tachypnea, and tachycardia. On auscultation, she had scattered wheezing in both lung fiends. Chest X-ray revealed small infiltrates in the lower lobe of both lungs. A nasopharyngeal swab for the COVID-19 polymerase chain reaction was positive. Later on, she developed sudden onset confusion accompanied by restlessness and visual hallucinations. Neurological examination revealed an altered level of consciousness, slight trembling of the limbs, psychomotor restlessness, and poor speech with no signs of meningeal irritation. Magnetic resonance imaging of the brain revealed diffuse hyperintense signals. A possible diagnosis of acute encephalitis was made due to concurrent COVID-19 infection and lack of other findings suggesting a diagnosis other than COVID-19. She was treated with azithromycin, tocilizumab, and methylprednisolone. Her condition started improving gradually.

Encephalitis in Patients with COVID-19: A Systematic Evidence-Based Analysis

“…Several cases developed neurological impairment following respiratory symptoms. The latency between the onset of the infection with respiratory manifestations and the onset of neurological complications varied between 3 days and 41 days [ 12 , 24 , 27 , 28 , 30 , 32 , 34 , 36 , 37 , 43 , 45 , 51 , 56 , 58 , 64 , 65 , 70 , 76 , 80 , 81 , 82 , 83 , 85 , 86 , 89 , 90 , 91 , 93 , 94 ]. Overall, 13 patients were intubated and mechanically ventilated due to respiratory distress; in these cases, the detection of neurological impairment happened when sedation was interrupted, with latency ranging between 4 and 38 days depending on the case [ 27 , 32 , 34 , 76 , 80 , 82 , 85 , 93 ].…”

“…Sleep disturbances, progressive altered mental status, psychiatric behavioural symptoms, and hallucination have been described by some authors [ 22 , 26 , 37 , 47 , 51 , 52 , 56 , 58 , 63 , 72 , 73 , 75 , 78 , 81 , 86 , 89 , 94 ]; most of these cases are associated with EEG representations [ 22 , 26 , 37 , 63 , 74 , 75 ], and some with brain neuroimaging alteration [ 51 , 52 , 56 , 78 , 81 , 94 ]. Neurological deficit referred to language deficit, cognitive deficits, akinetic syndrome with mutism, signs of cortical impairment, seizures, stroke, cerebellar signs, chorea, paralysis, coma, and signs of brain death [ 17 , 25 , 33 , 36 , 37 , 38 , 39 , 47 , 49 , 51 , 52 , 53 , 58 , 59 , 60 , 64 , 65 , 71 , 72 ,…”

“…Until 2021, therapeutical plasmapheresis and immunosuppressive drugs were rarely prescribed. After the first period of the COVID-19 pandemic, immunomodulating agents, in particular IVIG and tocilizumab, plasmapheresis, and convalescent’s serum, have been used more often, with good response [ 21 , 51 , 59 , 60 , 70 , 81 , 83 , 88 ], except for the most severe cases, like in ANHE.…”

COVID-19 Presenting as Encephalitis and Myopericarditis: A Report of a Rare Case

“…The pathophysiological mechanism of acute encephalitis in COVID-19 is not well defined. Several mechanisms could explain neurological manifestations associated with COVID-19, including direct neural invasion, para-or post-infectious immunological disorder, potential neurotoxicity of therapeutic agents, and toxic/metabolic encephalopathy, especially in the context of the high burden of proinflammatory cytokines that characterizes severe COVID-19 [10][11][12][13][14].…”

Multiple Sclerosis Following SARS-CoV-2 Infection: A Case Report and Literature Review

“…Coronavirus disease 19 (COVID- 19) is caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), which typically manifests with fever, myalgia, and signs and symptoms of the respiratory system and causes substantial morbidity and mortality in severe cases such as multiorgan failure and acute respiratory distress syndrome [1][2][3][4]. The novel coronavirus is also a neurotropic virus causing complications in both the central and peripheral nervous systems, particularly during the post-recovery phase with a prevalence of 36% after a viral infection, and those complications include polyneuropathies, headache, seizures, ataxia, cerebrovascular diseases, and demyelinating diseases [5][6]. Demyelinating disorder, such as multiple sclerosis following a COVID-19 infection, has also been reported in the literature [7].…”