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New disease
Case report
COVID-19-associated meningoencephalitis treated with intravenous immunoglobulin
  1. Rayan S El-Zein1,
  2. Serge Cardinali1,
  3. Christie Murphy1 and
  4. Thomas Keeling2
  1. 1Department of Internal Medicine, OhioHealth Doctors Hospital, Columbus, OH, USA
  2. 2Department of Infectious Disease, OhioHealth Doctors Hospital, Columbus, OH, USA
  1. Correspondence to Dr Christie Murphy; cmazurk1{at}aol.com

Abstract

A 40-year-old man presented with altered mental status after a recenthospitalisation for COVID-19 pneumonia. Cerebrospinal fluid (CSF) analysis showed lymphocytosis concerning for viral infection. The CSF PCR for SARS-CoV-2 was negative, yet this could not exclude COVID-19 meningoencephalitis. During hospitalisation, the patient’s mentation deteriorated further requiring admission to the intensive care unit (ICU). Brain imaging and electroencephalogram (EEG) were unremarkable. He was, thus, treated with intravenous immunoglobulin (IVIg) for 5 days with clinical improvement back to baseline. This case illustrates the importance of considering COVID-19’s impact on the central nervous system (CNS). Haematogenous, retrograde axonal transport, and the effects of cytokine storm are the main implicated mechanisms of CNS entry of SARS-CoV-2. While guidelines remain unclear, IVIg may be of potential benefit in the treatment of COVID-19-associated meningoencephalitis.

  • infections
  • infection (neurology)

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/bcr-2020-237364

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    Footnotes

    • Twitter @Rayan_ElZein

    • Contributors RSE, SC and TK participated in the care of the patient. Report was written by RSE, SC and CM.

    • 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.