Myeloencephalitis as the only presentation of Omicron SARS-CoV-2 infection

Abstract

SARS-CoV-2 is now a major global health issue and manifests mainly as a respiratory disorder. Several other complications involving hypercoagulability, cardiovascular system and central nervous system have been described in the literature. Among these atypical presentations, encephalopathy associated with SARS-CoV-2 is a rare entity with heterogenous clinical and radiological findings. The direct presence of SARS-CoV-2 in cerebrospinal fluid (CSF) was rarely found in encephalopathy patients with acute SARS-Cov-2 infection.Here, we report a case of myeloencephalitis with positive real-time PCR for SARS-CoV-2 in CSF in a young woman presenting exclusively with neurological symptoms. Other differential diagnosis were extensively pursued by a comprehensive aetiological workup. To our knowledge, this is the first case report in the Omicron era. In the context of recent global explosion of SARS-Cov-2 infections, clinicians should consider this pathogen among other possible neurotropic agents and be familiar with its radiological and clinical presentations.

Neurological complications during the Omicron COVID‐19 wave in China: A cohort study

“…Previous studies do not support changing the approach to acute stroke management in people infected with COVID-19. In people with encephalitis/encephalopathy, antivirals and corticosteroids were used based on experience and without high-quality evidence [22]. Previous cases also had a successful experience using early combined antiviral therapy or hybrid continuous renal replacement therapy and plasma exchange in critical encephalopathy [24,25].…”

“…CSF PCR was unavailable for most cases due to a lack of supply. Severe encephalitis/encephalopathy has been reported frequently in children, including neonates with Omicron infection [18][19][20][21], and fewer cases were reported in adults [22][23][24]. Most CSF samples tested negative for the Omicron variant [18,[22][23][24].…”

Increased neurovirulence of omicron BA.5 over BA.1 in human brain organoids and K18-hACE2 mice

“…A number of studies have now shown brain infection in COVID-19 patients [37][38][39][40][41] , with, for instance, viral RNA or protein detected in the brains of 20-38% of patients that died of COVID-19 42,43 . A number of groups have also reported detection of viral RNA in cerebrospinal uid of COVID-19 patients [44][45][46][47][48] , including patients infected with omicron virus strains 49 . Finally, COVID-19-associated damage to the brain is also likely to be associated with neurological manifestations of long-COVID 5,50−52 , and such damage may also contribute to the continuing excess deaths arising from the COVID-19 pandemic [53][54][55] .…”

Increased neurovirulence of omicron BA.5 and XBB variants over BA.1 in K18-hACE2 mice and human brain organoids

“…A number of studies have now shown brain infection in COVID-19 patients [33][34][35][36][37] , with viral RNA or protein detected in the brains of 20-38% of patients that died of COVID-19 38,39 . A number of groups have also reported detection of viral RNA in cerebrospinal fluid of COVID-19 patients [40][41][42][43][44] , including patients infected with omicron virus 45 .…”

“…For instance, viral RNA or protein detected in the brains of 20-38% of patients that died of COVID-19 (Matschke et al, 2020; Serrano et al, 2022). A number of groups have also reported detection of viral RNA in cerebrospinal fluid of COVID-19 patients (Supplementary Table 1), including patients infected with omicron virus strains (Dang et al, 2022). Finally, COVID-19-associated damage to the brain is also likely to be associated with neurological manifestations of long-COVID (Davis et al, 2023; de Paula et al, 2023; Ferrucci et al, 2023; Rothstein, 2023), and such damage may also contribute to the continuing excess deaths arising from the COVID-19 pandemic (De Hert et al, 2021; Li et al, 2021; Msemburi et al, 2023).…”