SARS-CoV-2 infection leading to ischemic and hemorrhagic brain lesions and acute respiratory distress syndrome

Coronavirus disease 2019 (COVID-19) may present with pulmonary and extrapulmonary manifestations. We present a 41-year-old patient who presented with 1 week of increasing dyspnea and fever and initial chest radiography demonstrated bilateral diffuse infiltrates. Due to the patient's progressively worsening symptoms, he was intubated, paralyzed, sedated. He began proning, 100% fractional inspired oxygenation ventilation, and veno-venous extracorporeal membrane oxygenation. Computed tomography of the thorax revealed completely opacified lungs bilaterally with the exception of a small, aerated apicoposterior segment of the left lung. Computed tomography of the head demonstrated several areas of hemorrhage, areas of hypodensity consistent with posterior cerebral artery and middle cerebral artery territory infarcts, and findings consistent with transtentorial herniation. Given the radiologic findings and nonprogressive clinical status, the family placed the patient on comfort care and the patient died within minutes of extubation. As with our patient at the time of admission, presenting symptoms and clinical laboratory data provide reliable prognostic factors for patients with COVID-19.