Autoimmune encephalitis as a complication of COVID-19 infection: a case report

Dahshan, Ahmed; Abdellatef, Abeer

doi:10.1186/s43162-022-00119-7

Cited by 7 publications

(9 citation statements)

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“…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 ].…”

Section: Resultsmentioning

confidence: 99%

“…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 ,…”

Section: Resultsmentioning

confidence: 99%

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

Islam

Cavestro

Alam

et al. 2022

Cells

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Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) predominantly infects the respiratory system, several investigations have shown the involvement of the central nervous system (CNS) along the course of the illness, with encephalitis being one of the symptoms. The objective of this systematic review was to evaluate the characteristics (clinical, neuro-radiological aspects, and laboratory features) and outcomes of encephalitis in COVID-19 patients. PubMed, Scopus, and Google Scholar databases were searched from 1 December 2019 until 21 July 2022 to identify case reports and case series published on COVID-19 associated with encephalitis. The quality of the included studies was assessed by the Joanna Briggs Institute critical appraisal checklists. This systematic review included 79 studies, including 91 COVID-19 patients (52.7% male) experiencing encephalitis, where 85.6% were adults (49.3 ± 20.2 years), and 14.4% were children (11.2 ± 7.6 years). RT-PCR was used to confirm 92.2% of the COVID-19 patients. Encephalitis-related symptoms were present in 78.0% of COVID-19 patients at the time of diagnosis. In these encephalitis patients, seizure (29.5%), confusion (23.2%), headache (20.5%), disorientation (15.2%), and altered mental status (11.6%) were the most frequently reported neurologic manifestations. Looking at the MRI, EEG, and CSF findings, 77.6%, 75.5%, and 64.1% of the patients represented abnormal results. SARS-CoV-2-associated or -mediated encephalitis were the most common type observed (59.3%), followed by autoimmune encephalitis (18.7%). Among the included patients, 66.7% were discharged (37.8% improved and 28.9% fully recovered), whereas 20.0% of the reported COVID-19-positive encephalitis patients died. Based on the quality assessment, 87.4% of the studies were of high quality. Although in COVID-19, encephalitis is not a typical phenomenon, SARS-CoV-2 seems like a neuropathogen affecting the brain even when there are no signs of respiratory illness, causing a high rate of disability and fatality.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Islam

Cavestro

Alam

et al. 2022

Cells

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“…[1][2][3] La EA por anticuerpos NMDA-r es uno de los subtipos autoinmunes más frecuentes y puede estar asociada a algunas enfermedades neoplásicas o a virus, siendo el virus herpes simple el más reportado. 1,4 La identificación temprana y el tratamiento oportuno en los pacientes con EA son los pilares fundamentales, lo que determinaría su pronóstico. Se reporta que la tasa de prevalencia estimada para EA es de 13,7 por cada 100 000 habitantes.…”

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“…3 El diagnóstico de EA es definitivo en presencia uno o más de los 6 grupos mayores de síntomas y en el dosaje de anticuerpos, 3 Sin embargo, se requiere de criterios clínicos iniciales para definir el diagnóstico con los que se inicia la sospecha de EA, el cual nos debe conducir al inicio de inmunoterapia empírica oportuna para evitar secuelas neurológicas graves. 2,4 En el 2020, durante la pandemia del COVID-19, empezaron a reportarse los primeros casos de EA asociados a la infección del SARS-Cov-2. Inicialmente, se desconocían las manifestaciones neurológicas de esta entidad, así como también los criterios diagnósticos y su respectivo manejo.…”

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“…Inicialmente, se desconocían las manifestaciones neurológicas de esta entidad, así como también los criterios diagnósticos y su respectivo manejo. 4,5 Posteriormente, las series de casos permitieron describir y conocer mejor esta patología, identificándose que el SARS-CoV-2 es un potente desencadenante de enfermedades innatas por una sobreproducción de citocinas inflamatorias. 6,7 Dicha infección parece impulsar algunas manifestaciones neurológicas en la fase aguda.…”

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Encefalitis autoinmune por anticuerpos NMDA-R en tiempos del COVID-19

Bazalar

Azañero-Haro

Piscoya

et al. 2023

spmi

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Mujer de 19 años que inició con cuadro respiratorio y posteriormente presentó cuadro subagudo con trastorno conductual y neurológico asociado a alucinaciones, agresividad, mutismo, crisis epilépticas, discinesias faciales y fiebre. La resonancia fue normal, el EEG registró ondas delta, los estudios de LCR y séricos fueron negativos para causas secundarias. Se inició tratamiento con aciclovir, anticonvulsivantes y, posteriormente, recibió metilprednisolonacon inmunoglobulina sin respuesta satisfactoria. Se inició tratamiento con rituximab presentando una respuesta favorable. El panel en LCR fue positivo a NMDAr. Es importante reconocer tempranamente las manifestaciones neuropsiquiátricas de esta patología para un manejo oportuno teniendo un impacto positivo en el pronóstico a largo plazo.

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The clinical, diagnostic and treatment spectrum of seropositive and seronegative autoimmune encephalitis: Single‐center cohort study of 51 cases and review of the literature

Elrefaey,

Mohamedelkhair,

Fahmy

et al. 2024

Clinical & Exp Neuroim

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ObjectiveAutoimmune encephalitis (AE) comprises a spectrum of inflammatory neurological syndromes characterized by immune responses to neuronal autoantigens, leading to diverse clinical manifestations, particularly behavioral and cognitive decline.MethodsThis single‐center retrospective study included 51 patients diagnosed with AE from 2013 to 2019 in a southeast Michigan tertiary care hospital. Patients were then divided into two groups, seropositive AE (AE+) and seronegative AE (AE−), based on antibody detection in the serum, cerebrospinal fluid or both when available. The study compares AE+ and AE− subtypes across clinical, diagnostic, and therapeutic parameters.ResultsA total of 34 patients were classified as AE+, and 17 as AE−. Demographic analysis showed no significant differences in age, sex or race between the two groups. Clinical presentations varied widely, encompassing psychiatric symptoms, movement disorders, seizures and confusion; 24% patients had a prior malignancy. Laboratory assessments found diverse autoantibodies in AE+ patients' serum. Radiological and electrophysiological assessments showed no significant differences between the groups. AE− patients had higher rates of confusion compared with AE+ patients (59% vs. 18%, P = 0.004).ConclusionsThis study focuses on the complexities associated with diagnosing AE, emphasizing the challenges posed by the heterogeneity of symptoms and often negative antibody test results. Rapid identification of AE, regardless of seropositivity or seronegativity, emerges as a critical factor for clinicians, facilitating the prompt initiation of immunotherapy and/or tumor removal if needed. These insights contribute to a better understanding of the landscape of this condition, offering clinicians the tools to refine their diagnostic and treatment strategies. Ultimately, the study aimed to enhance the management of AE, empowering healthcare professionals to make accurate and timely interventions for patients.

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Autoimmune encephalitis as a complication of COVID-19 infection: a case report

Cited by 7 publications

References 9 publications

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

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

Encefalitis autoinmune por anticuerpos NMDA-R en tiempos del COVID-19

The clinical, diagnostic and treatment spectrum of seropositive and seronegative autoimmune encephalitis: Single‐center cohort study of 51 cases and review of the literature

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