First case of encephalitis linked to COVID-19 reported
Doctors at Henry Ford Health Detroit, Michigan, have reported first ever presumptive case of acute necrotizing hemorrhagic encephalopathy associated with COVID-19.Thr case has been published in Radiology.
According to history a 58-year-old woman presented with a 3-day history of fever, cough, and muscle aches ― symptoms consistent with COVID-19. She showed signs of confusion, lethargy, and disorientation when she reached hospital.
The woman tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with a rapid COVID-19 test.She was later diagnosed with acute hemorrhagic necrotizing encephalopathy. Her
CT and MRI scans helped reach the diagnosis
Noncontrast head CT revealed "symmetric hypoattenuation within the bilateral medial thalami with a normal CT angiogram and CT venogram," the team reports in their article. Brain MRI showed "hemorrhagic rim enhancing lesions within the bilateral thalami, medial temporal lobes, and subinsular regions."Elissa Fory, MD, a neurologist with Henry Ford who was part of the team of medical experts that made the diagnosis, said
The patient was started on intravenous immunoglobulin but not high-dose steroids, because of concern for respiratory compromise. As of April 1, the patient was hospitalized in serious condition.
Acute necrotizing encephalopathy (ANE) is a rare complication of influenza and other viral infections and has been related to intracranial cytokine storms, which result in blood-brain-barrier breakdown, but without direct viral invasion or parainfectious demyelination. A recent report in the Lancet suggested that a subgroup of patients with severe COVID-19 might develop a cytokine storm syndrome.
As the number of patients with COVID-19 increases worldwide, clinicians and radiologists should be watching for this presentation among patients presenting with COVID-19 and altered mental status," the clinicians advise.
Brent Griffith, MD, radiologist with Henry Ford and senior author of the case report, said the case shows "the important role that imaging can play in COVID-19 cases."
"This is significant for all providers to be aware of and looking out for in [COVID-19] patients who present with an altered level of consciousness. This complication is as devastating as severe lung disease," Elissa Fory, MD, a neurologist with Henry Ford who was part of the team of medical experts that made the diagnosis, said in a statement.
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