Simultaneous Encephalitis and Neuroretinitis After COVID-19 in a Young Adult: A Case Report

Abstract

Coronavirus disease 2019 (COVID-19) pandemic greatly impacted many aspects of life in the world. Both neurological and ophthalmologic presentations after COVID-19 have been reported. Herein, we present a case of both neuroretinitis and encephalitis after COVID-19 in a young adult. Both presentations are among the rare presentations of COVID-19. Similar manifestations were not reported previously. The 18-year-old previously healthy girl initially presented with low-grade fever, nausea, vomiting, body pain, and headache. The patient tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcriptase-polymerase chain reaction (PCR) by using a nasal swab. Two days after the onset of COVID-19 symptoms, she reported blurred vision in both eyes, progressing to only light perception in 3 days. Based on the ophthalmological evaluation, she was diagnosed with neuroretinitis. A few days later, she gradually became drowsy, so she was referred for neurological evaluation. Brain magnetic resonance imaging (MRI) showed bilateral medial temporal T2 and fluid-attenuated inversion recovery (FLAIR) hyper-signal lesions suggestive of encephalitis. A low-dose steroid was started to treat the neuroretinitis. After about 2 weeks, significant improvement in visual acuity and resolution of retinitis patches were observed. Our case is rare in respect of both neurological and ophthalmic involvement.

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

“…The last young girl mainly had retinal involvement, with subsequent encephalitis of the temporal lobes. Apart from fever, body pain, headache, and nausea with vomiting, the only neurologic symptom was drowsiness, and the prognosis was good [ 77 ].…”

Acute ischemic stroke and vaccine-induced immune thrombotic thrombocytopenia post COVID-19 vaccination; a systematic review

“…These symptoms may appear immediately after immunization and disappear quickly [ 8 ]. There are also reports of rare but potentially serious side effects such as arterial or venous thrombosis, Guillain-Barré syndrome (GBS), myocarditis, pericarditis, and glomerular disease [ 9 , 10 ]. AIS and cerebral venous sinus thrombosis (CVST) not only have been described as rare and serious neurological consequences of SARS-CoV-2 infection [ [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] ], but also have been outlined post COVID-19 vaccination [ 5 , [25] , [26] , [27] ].…”