A case of successive development of possible acute necrotizing encephalopathy after COVID-19 pneumonia

Abstract

COVID-19 infection often results in an excessive inflammatory response with a spectrum of neurological manifestations. Here, we describe an 81-year-old female with severe COVID-19 pneumonia and subsequent alteration of consciousness after high-dose intravenous dexamethasone and remdesivir. A non-contrast head computed tomography (CT) demonstrated bilateral hypodensities involving bilateral cerebellar hemispheres, thalami, cerebral peduncles and medial parieto-occipital areas. There was no improvement and repeat CT showed progression with findings suggestive of acute necrotizing encephalopathy. Interleukin-6 levels were initially normal; however, subsequent levels were found to be markedly elevated. Acute necrotizing encephalopathy associated with COVID-19 may occur in the setting of severe pneumonia and may represent an immune-mediated process involving inflammatory cytokines such as interleukin-6.

Case of Acute Necrotising Encephalopathy of Childhood secondary to Severe Acute Respiratory Syndrome Coronavirus 2 infection

“…Due to the immune dysregulation and predominately pro-inflammatory response associated with severe SARS-CoV-2, immunomodulation with biologics such as tocilizumab may be added as adjunctive therapy. 1 Neurological complications of SARS-CoV-2 are well reported in the adult population. 2 These include meningo-encephalitis, ischaemic stroke, Guillain-Barre syndrome and acute necrotising encephalopathies.…”

“…This report serves to highlight that ANEC is a rare but significant complication of acute SARS‐CoV‐2 infection and should be considered in children presenting with acute neurological signs and symptoms during a SARS‐CoV‐2 illness. Due to the immune dysregulation and predominately pro‐inflammatory response associated with severe SARS‐CoV‐2, immunomodulation with biologics such as tocilizumab may be added as adjunctive therapy 1 …”