Case of Post-Covid Acute haemorrhagic LeukoEncephalitis successfully treated at Apollo hospital

New Delhi: In the past few months, COVID 19 has been associated with many severe health complications it poses in the long run. Doctors at Indraprastha Apollo Hospital, came across one such rare case, which might be the first reported case of post-covid encephalitis in India. 55 year old Mithilesh Lambru from Jammu was diagnosed with Acute haemorrhagic LeukoEncephalitis: A neurological disorder: Encephalitis is caused by a virus that leads to immune system disorder causing inflammation in the brain.

Mr Lambru had contracted COVID 19 with mild symptoms, post which he went into home quarantine. However, his condition deteriorated rapidly leading to shortness of breath. He was urgently shifted to a local hospital in Jammu. Diagnosis revealed that owing to COVID 19 the patient had contracted Pneumonia of the Lungs and was hence put on ventilator. The doctors were not sure about the line of treatment considering the complexity and risk factors associated with patient's health as he suffered from multiple co-morbidities such as Diabetes and Hypertension. Thus, the local doctors had to call in a team of experts from Indraprastha Apollo Hospitals, New Delhi.

Within 24 Hours, an expert team of doctors comprising of Dr Mukesh Goel (Senior Consultant, Cardio Thoracic Surgeon), Dr Devjeevan (Senior Interventionist), Dr Priyadarshini Pal (Head of Emergency, Indraprastha Apollo Hospitals) along with a perfusionist (a healthcare professional who operates the ECMO machine) and a nursing assistant was formed. This team flew to Jammu, stabilised his oxygen ventilation and got the patient to Delhi via an air ambulance for further investigations and immediate treatment considering the fact that any further delay in treatment would have led to loss of life for the patient. He was admitted to Indraprastha Apollo Hospitals on December 1^st2020, under the supervision of Dr Rajesh Chawla, Senior Consultant, Pulmonology & Respiratory Disease.

Supervising the case Dr Rajesh Chawla, Senior Consultant, Pulmonology & Respiratory Disease, said, "When the team reached Jammu the patient was in a critical condition and unfit for travelling even on ECMO support considering the fact that his lungs had been severely affected due to Pneumonia and were not functioning properly. We first tried to stabilize his health as only post that he would be fit to be shifted via an air ambulance to Delhi. At Apollo he was admitted to the COVID ICU ward and we monitored his condition closely. While the patient manifested signs of recovery from COVID pneumonia within 2 days and was removed from the ventilator, we noticed that he had slipped into deep coma due to an underlying condition in his brain."

Dr Vinit Suri, Senior Consultant, Neurosciences, Indraprastha Apollo Hospitals, said, "Usually when patients recovering from COVID pneumonia are removed from sedation and muscle relaxants (after being on a ventilator) they come back to consciousness within hours, but that was not the case with Mr Lambru. His MRI revealed that there were multiple swellings in the brain along with over 400 micro blood clots (haemorrhagic spots). This condition worldwide in association with the SARS COV-2 virus has been identified as COVID Encephalitis (Acute haemorrhagic LeukoEncephalitis). Fortunately, we were able to diagnose this condition on time and with immune therapy and steroids we were able to gradually revive the patient within 7 days to a complete state of consciousness and alertness. While he still has slight weakness in his limbs, his post treatment MRI shows more than 50% recovery and the patient has been discharged on 26^th December."

Encephalitis causes inflammation in the brain and is manifested by epileptic seizures, fever and headache. Association of COVID 19 with Encephalitis is rare and only few cases have been reported worldwide. It is not the virus that hits the brain but it's the immune response towards the virus that causes inflammation in the brain