TY - JOUR
T1 - Spectrum of Hemorrhagic Encephalitis in COVID-19 Patients
T2 - A Case Series and Review
AU - Sharma, Rohan
AU - Nalleballe, Krishna
AU - Shah, Vishank
AU - Haldal, Shilpa
AU - Spradley, Thomas
AU - Hasan, Lana
AU - Mylavarapu, Krishna
AU - Vyas, Keyur
AU - Kumar, Manoj
AU - Onteddu, Sanjeeva
AU - Gokden, Murat
AU - Kapoor, Nidhi
N1 - Publisher Copyright:
© 2022 by the authors. Submitted for possible open access.
PY - 2022/4
Y1 - 2022/4
N2 - Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) is an ongoing pandemic that has affected over 400 million people worldwide and caused nearly 6 million deaths. Hemor-rhagic encephalitis is an uncommon but serious complication of COVID-19. The etiology of this disease is multifactorial, including secondary to severe hypoxemia, systemic inflammation, direct viral invasion, hypercoagulability, etc. The clinical spectrum of COVID-19-related hemorrhagic encephalitis is also varied, ranging from leukoencephalopathy with microhemorrhage, acute necrotiz-ing hemorrhagic encephalitis (ANHE) involving the cortex, basal ganglia, rarely brain stem and cervical spine, hemorrhagic posterior reversible encephalopathy syndrome (PRES) to superimposed co-infection with other organisms. We report a case series of three young patients with different presentations of hemorrhagic encephalitis after COVID-19 infection and a review of the literature. One patient had self-limiting ANHE in the setting of mild COVID-19 systemic illness. The second patient had self-limiting leukoencephalopathy with microhemorrhages in the setting of severe systemic diseases and ARDS, and clinically improved with the resolution of systemic illness. Both patients were healthy and did not have any premorbid conditions. The third patient with poorly con-trolled diabetes and hypertension had severe systemic illness with neurological involvement including multiple ischemic strokes, basal meningitis, hemorrhagic encephalitis with pathological ev-idence of cerebral mucormycosis, and Epstein–Barr virus coinfection, and improved after antifungal therapy.
AB - Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) is an ongoing pandemic that has affected over 400 million people worldwide and caused nearly 6 million deaths. Hemor-rhagic encephalitis is an uncommon but serious complication of COVID-19. The etiology of this disease is multifactorial, including secondary to severe hypoxemia, systemic inflammation, direct viral invasion, hypercoagulability, etc. The clinical spectrum of COVID-19-related hemorrhagic encephalitis is also varied, ranging from leukoencephalopathy with microhemorrhage, acute necrotiz-ing hemorrhagic encephalitis (ANHE) involving the cortex, basal ganglia, rarely brain stem and cervical spine, hemorrhagic posterior reversible encephalopathy syndrome (PRES) to superimposed co-infection with other organisms. We report a case series of three young patients with different presentations of hemorrhagic encephalitis after COVID-19 infection and a review of the literature. One patient had self-limiting ANHE in the setting of mild COVID-19 systemic illness. The second patient had self-limiting leukoencephalopathy with microhemorrhages in the setting of severe systemic diseases and ARDS, and clinically improved with the resolution of systemic illness. Both patients were healthy and did not have any premorbid conditions. The third patient with poorly con-trolled diabetes and hypertension had severe systemic illness with neurological involvement including multiple ischemic strokes, basal meningitis, hemorrhagic encephalitis with pathological ev-idence of cerebral mucormycosis, and Epstein–Barr virus coinfection, and improved after antifungal therapy.
KW - COVID-19
KW - hemorrhagic encephalitis
KW - mucormycosis
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U2 - 10.3390/diagnostics12040924
DO - 10.3390/diagnostics12040924
M3 - Article
C2 - 35453972
AN - SCOPUS:85128704038
SN - 2075-4418
VL - 12
JO - Diagnostics
JF - Diagnostics
IS - 4
M1 - 924
ER -