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Case report
Neurotropism of SARS-CoV-2: COVID-19 presenting with an acute manic episode
  1. Jamie A Mawhinney1,
  2. Catherine Wilcock2,
  3. Hasan Haboubi3 and
  4. Shahbaz Roshanzamir2
  1. 1 Academic Department of Vascular Surgery, King's College London, London, UK
  2. 2 Department of Ageing and Health, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
  3. 3 Department of Gastroenterology, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
  1. Correspondence to Dr Jamie A Mawhinney; jamiemawhinney12{at}


A 41-year-old man with no significant medical history presented with acute behavioural disruption on the background of a 1-day history of severe headache and a 10-day history of dry cough and fever. He was sexually disinhibited with pressured speech and grandiose ideas. His behaviour worsened, necessitating heavy sedation and transfer to intensive care for mechanical ventilation despite no respiratory indication. Investigations confirmed that he was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Neuroimaging and a lumbar puncture were normal. Initial screening for SARS-CoV-2 in the cerebrospinal fluid was negative although no validated assay was available. The patient’s mental state remained abnormal following stepdown from intensive care. Psychiatric assessment found features consistent with acute mania, and he was detained under the Mental Health Act. This case indicates the need to consider COVID-19 in a wider series of clinical presentations and to develop a validated assay for SARS-CoV-2 in the cerebrospinal fluid.

  • pneumonia (infectious disease)
  • infection (neurology)
  • psychotic disorders (incl schizophrenia)
  • mood disorders (including depression)

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  • Contributors All authors were the acute medical team managing the patient. JAM wrote the manuscript and CW, HH and SR reviewed the manuscript and provided insight into further research in the field.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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