Atypical Eclampsia in a Pregnant Woman Infected by COVID-19

Abstract

The coronavirus disease 2019, also called (COVID-19), is an infectious disease which is caused by a virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first report was in December 2019, and on March 12, 2020, the World Health Organization (WHO) declared this disease a pandemic. COVID-19 targets many major organs causing life-threatening systemic complications. It can cause lung damage and respiratory failure in addition to systemic inflammation and immune dysregulation. Hypercoagulable state and numerous neurological abnormalities also have been reported due to this condition. Going through the literature review, we found some cases of pregnant women with novel coronavirus infection, being mostly mild illnesses, and most of these cases were focused on maternal-fetal transmission and neonatal outcomes. In this case report, we present the case of a COVID-19 positive woman who came to our emergency department at 34 weeks of gestation with tonic-clonic seizures. This case was a challenge for us because we faced a new an unknown manifestation of both COVID and eclampsia.

Atypical eclampsia in a normotensive patient with altered mental status and severely elevated transaminases: Case report and review

“…The literature contains additional case reports of atypical eclampsia (Table 2) in which the seizures were refractory to standard medical management 16–18 or in which they developed prior to 20 weeks' gestational age, 19,20 in the late postpartum period, 21–25 in the absence of proteinuria, 16,22,24,25 or in the absence of elevated blood pressures 17,21,22,24–28 . Eclampsia infrequently occurs without pre‐existing or subsequent hypertension, and our report adds to the limited number of such cases in the literature.…”

“…Odeh et al 27 Normotensive 28-year-old at 34 weeks and 3 days who presented with two episodes of tonic-clonic seizure (tongue biting, up-rolling eyes) which lasted 1 min each and were associated with loss of consciousness. She was also COVID-19-positive.…”

“…found that hypertension was absent in 16% of cases in a series of 399 women with eclampsia. To our knowledge, there have been fewer than 25 reported cases since then of atypical eclampsia in persistently normotensive patients, 17,21,22,[24][25][26][27][28] with only one of these cases occurring in the United States. 24 Among these normotensive patients with atypical eclampsia, only one had a reported abnormal transaminase value, with a slightly elevated AST of 66 U/L and a normal ALT of 35 U/L.…”

A Systematic Review of Neurological Complications in Pregnant Women With COVID-19

“…Preeclampsia incidence increased after previous research on other coronaviruses, such as Middle East Respiratory Disease (MERS) and SARS, was conducted. Common neurological symptoms of this virus range from headache, dizziness, and loss of taste and smell to severe cerebrovascular problems, encephalopathy, ataxia, skeletal muscle manifestations, viral encephalitis, seizures, and even death [ 5 ].…”

“…Preeclampsia is a problem that can happen during pregnancy. It is linked to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection much more frequently, and the severity of COVID-19 is also linked to preeclampsia [5]. One of the most common signs of COVID-19 is a neurological symptom, such as tiredness or a headache.…”