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Acute Necrotizing Encephalitis as a Probable Association of COVID-19
Neeraj Kumar1, Subhash Kumar2, Abhyuday Kumar3
1Department of Trauma and Emergency, All India Institute of Medical Sciences, Patna, Bihar, India.
Insights
This case study reports a rare instance of acute necrotizing encephalitis as the sole initial symptom of COVID-19. Early identification via CT scans is crucial for managing this neurological complication.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Coronavirus disease-2019 (COVID-19) has affected millions globally.
- Neurological manifestations of COVID-19 are increasingly recognized.
- Acute necrotizing encephalopathy (ANE) is a rare but serious complication of viral infections, linked to cytokine storms and blood-brain barrier disruption.
Observation:
- A 35-year-old male presented with unconsciousness, fever, and vomiting.
- Brain MRI revealed a parasellar-middle cranial fossa mass, suspected meningioma.
- NCCT brain showed the mass with hypodensities in the thalami and caudate nucleus.
Findings:
- The patient's presentation was diagnosed as acute necrotizing encephalitis.
- This encephalitis was the solitary manifestation of COVID-19.
- Normal cerebrospinal fluid (CSF) and chest X-ray (CXR) findings were noted.
Implications:
- This case underscores the importance of considering encephalitis as an initial COVID-19 symptom.
- Noncontrast computed tomography (NCCT) findings can be key in diagnosing COVID-19-associated encephalitis, even with normal CSF and CXR.
- Prompt identification is vital for managing this rare neurological complication.
Background:
Meanwhile, over 50 lakh people have now been affected by coronavirus disease-2019 (COVID-19) across the globe. There are various reports on neurological manifestations of COVID-19, which have attracted broad attention. Acute necrotizing encephalopathy (ANE) is a rare complication of influenza and other viral infections and has been related to intracranial cytokine storm, which results in breach in blood-brain barrier leading to encephalitis like presentation. We report an unusual case of acute necrotizing encephalitis as a solitary presentation of COVID-19.
Case Description:
We report a case of 35-year-old man from Bihar, presented to our emergency department in unconscious state, with high-grade fever and vomiting since last 5 days. Previous magnetic resonance imaging (MRI) brain showed a left parasellar-middle cranial fossa mass looks most likely like an invasive meningioma. Urgent noncontrast computed tomography scan (NCCT) brain showed that mass as well as hypodensities in both thalami and left caudate nucleus. As per our institutional protocol, clinical management of raised intracranial pressure was initiated. As there is no current evidence from any randomized control trails (RCTs) to recommend any specific treatment for suspected or confirmed patients with COVID-19 with acute necrotizing encephalitis.
Conclusion:
Our case highlights the importance of identifying encephalitis as a presenting sign of COVID-19 based on NCCT findings with normal cerebrospinal fluid (CSF) and normal chest X-ray (CXR) findings.
How To Cite This Article:
Kumar N, Kumar S, Kumar A, Pati BK, Kumar A, Singh C, et al. Acute Necrotizing Encephalitis as a Probable Association of COVID-19. Indian J Crit Care Med 2020;24(10):991-994.
