RT Journal Article
SR Electronic
T1 Neurotropism of SARS-CoV-2: COVID-19 presenting with an acute manic episode
JF BMJ Case Reports
JO BMJ Case Reports
FD BMJ Publishing Group Ltd
SP e236123
DO 10.1136/bcr-2020-236123
VO 13
IS 6
A1 Jamie A Mawhinney
A1 Catherine Wilcock
A1 Hasan Haboubi
A1 Shahbaz Roshanzamir
YR 2020
UL http://casereports.bmj.com/content/13/6/e236123.abstract
AB 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.