Steroid-Responsive Encephalitis in Coronavirus Disease 2019

Andrea Pilotto; Silvia Odolini; Stefano Masciocchi; Agnese Comelli; Irene Volonghi; Stefano Gazzina; Sara Nocivelli; Alessandro Pezzini; Emanuele Focà; Arnaldo Caruso; Matilde Leonardi; Maria P Pasolini; Roberto Gasparotti; Francesco Castelli; Nicholas J Ashton; Kaj Blennow; Henrik Zetterberg; Alessandro Padovani

doi:10.1002/ana.25783

Steroid-Responsive Encephalitis in Coronavirus Disease 2019

Ann Neurol. 2020 Aug;88(2):423-427. doi: 10.1002/ana.25783. Epub 2020 Jun 9.

Authors

Andrea Pilotto^{1

2}, Silvia Odolini³, Stefano Masciocchi¹, Agnese Comelli³, Irene Volonghi¹, Stefano Gazzina⁴, Sara Nocivelli¹, Alessandro Pezzini¹, Emanuele Focà³, Arnaldo Caruso⁵, Matilde Leonardi⁶, Maria P Pasolini⁴, Roberto Gasparotti⁷, Francesco Castelli³, Nicholas J Ashton^{8

9

10

11}, Kaj Blennow^{8

12}, Henrik Zetterberg^{8

12

13

14}, Alessandro Padovani¹

Affiliations

¹ Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
² Parkinson's Disease Rehabilitation Centre, FERB ONLUS - S. Isidoro Hospital, Trescore Balneario (BG), Italy.
³ University Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy.
⁴ Neurophysiology Unit, ASST Spedali Civili of Brescia, Brescia, Italy.
⁵ Microbiology Unit, Department of Molecular and Translational Medicine, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy.
⁶ Neurology, Public Health, Disability Unit - IRCCS Neurology Institute Besta, Milan, Italy.
⁷ Neuroradiology Unit, Department of Molecular and Translational Medicine, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy.
⁸ Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.
⁹ Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.
¹⁰ King's College London, Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Institute Clinical Neuroscience Institute, London, UK.
¹¹ NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation, London, UK.
¹² Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.
¹³ Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK.
¹⁴ UK Dementia Research Institute at UCL, London, UK.

Abstract

Coronavirus disease 2019 (COVID-19) infection has the potential for targeting the central nervous system, and several neurological symptoms have been described in patients with severe respiratory distress. Here, we described the case of a 60-year-old patient with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection but only mild respiratory abnormalities who developed an akinetic mutism attributable to encephalitis. Magnetic resonance imaging was negative, whereas electroencephalography showed generalized theta slowing. Cerebrospinal fluid analyses during the acute stage were negative for SARS-CoV-2, positive for pleocytosis and hyperproteinorrachia, and showed increased interleukin-8 and tumor necrosis factor-α concentrations. Other infectious or autoimmune disorders were excluded. A progressive clinical improvement along with a reduction of cerebrospinal fluid parameters was observed after high-dose steroid treatment, thus arguing for an inflammatory-mediated brain involvement related to COVID-19. ANN NEUROL 2020;88:423-427.

Publication types

Case Reports

MeSH terms

Akinetic Mutism / physiopathology*
Antiviral Agents / therapeutic use*
Betacoronavirus
COVID-19
COVID-19 Drug Treatment
Coronavirus Infections / cerebrospinal fluid
Coronavirus Infections / complications
Coronavirus Infections / drug therapy*
Coronavirus Infections / physiopathology
Drug Combinations
Electroencephalography
Encephalitis / cerebrospinal fluid
Encephalitis / complications
Encephalitis / drug therapy*
Encephalitis / physiopathology
Glucocorticoids / therapeutic use*
Humans
Hydroxychloroquine / therapeutic use
Interleukin-6 / cerebrospinal fluid
Interleukin-8 / cerebrospinal fluid
Lopinavir / therapeutic use
Magnetic Resonance Imaging
Male
Methylprednisolone / therapeutic use*
Middle Aged
Pandemics
Pneumonia, Viral / cerebrospinal fluid
Pneumonia, Viral / complications
Pneumonia, Viral / drug therapy*
Pneumonia, Viral / physiopathology
Ritonavir / therapeutic use
SARS-CoV-2
Treatment Outcome
Tumor Necrosis Factor-alpha / cerebrospinal fluid
beta 2-Microglobulin / cerebrospinal fluid

Substances

Antiviral Agents
Drug Combinations
Glucocorticoids
Interleukin-6
Interleukin-8
Tumor Necrosis Factor-alpha
beta 2-Microglobulin
lopinavir-ritonavir drug combination
Lopinavir
Hydroxychloroquine
Ritonavir
Methylprednisolone