Case Report of 78 –year-old man with meningitis, Pulmonary Thromboembolism & SARS-Coronavirus-2 infection

Abstract

The novel corona virus infection involve both Central & Peripheral Nervous System . Some of the presentations include: acute cerebrovascular disease, impaired consciousness, transverse myelitis, encephalopathy, encephalitis and epilepsy. Our patient was 78 year –old man with dementia and diabetic nephropathy which was admitted two times for possibly COVID19 infection. At the first hospitalization, the patient is treated with hydroxychloroquine and kaletra based on clinical symptoms and initial laboratory findings due to suspicion of COVID19 . After the negative RT-PCR test of nasopharyngeal sample for covid19 and evidence of aspiration pneumonia in CT scan, the patient was discharged with oral antibiotics. Five weeks later, he was rehospitalized with loss of consciousness, fever and hypoxemia in physical exam he had neck stiffness in all directions, So the CNS infection was suspected, the CSF sample was in favor of aseptic meningitis and second RT-PCR test of nasopharyngeal sample for COVID19 was positive but Brain MRI just showed small vessel disease without evidence of encephalitis. In the second hospitalization, he had acute renal failure, which was treated with supportive care, and also suffered from pulmonary embolism with cavitary lesions in his lungs. Meningitis with pulmonary embolism and acute renal failure have not yet reported. Our patient is the first one, so we decided to share it. This case showed different presentation of COVID19 without typical lung involvement. So we must pay attention to any sign & symptoms in a patient suspected of having a COVID19 .

Cytokine storm induced by SARS-CoV-2 infection: The spectrum of its neurological manifestations

“…His MRI showed hyperintensity along the wall of the right lateral ventricle and hyperintense signal changes in the right mesial temporal lobe and hippocampus. COVID-19 induced meningitis was also reported in a 78-year-old man with pulmonary embolism and acute renal failure [61] . Viral meningitis has been linked to cytokine storm, especially with elevated IL-6 and IFN-γ [62] .…”