COVID-19-associated necrotizing encephalopathy presenting without active respiratory symptoms: a case report with histopathology

Leigh A Rettenmaier; Lama Abdel-Wahed; Hisham Abdelmotilib; Kyle S Conway; Nandakumar Narayanan; Christopher L Groth

doi:10.1007/s13365-021-01042-3

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COVID-19-associated necrotizing encephalopathy presenting without active respiratory symptoms: a case report with histopathology

Journal article

Open access

Peer reviewed

COVID-19-associated necrotizing encephalopathy presenting without active respiratory symptoms: a case report with histopathology

Leigh A Rettenmaier, Lama Abdel-Wahed, Hisham Abdelmotilib, Kyle S Conway, Nandakumar Narayanan and Christopher L Groth

Journal of neurovirology, Vol.28(1), pp.172-176

12/30/2021

DOI: 10.1007/s13365-021-01042-3

PMCID: PMC8718039

PMID: 34970720

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Abstract

Acute necrotizing encephalopathy (ANE) is a rare complication of coronavirus disease 2019 (COVID-19) secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The condition is typically diagnosed based on characteristic neuroimaging findings in the context of active viral respiratory symptoms. We present a rare case of COVID-19-associated ANE presenting with expressive aphasia and encephalopathy in the absence of active respiratory symptoms. Initial evaluation revealed bilateral thalamic lesions and a mild neutrophilic-predominant pleocytosis on cerebrospinal fluid analysis, the latter of which has not been described in previously published cases. Presence of these atypical features prompted extensive diagnostic evaluation. Metagenomic next-generation sequencing on cerebrospinal fluid did not detect the presence of pathogenic nucleic acids. Thalamic biopsy revealed perivascular neutrophilic inflammation suggestive of small vessel vasculitis with surrounding hemorrhage and necrosis. Ultimately, the diagnosis was made following detection of SARS-CoV-2 serologies and after exclusion of alternative etiologies. The patient was successfully treated with a short course of high-dose methylprednisolone with favorable outcome.

COVID-19

SARS-CoV-2

Histopathology

Next-generation sequencing

MRI

Details

Title: Subtitle: COVID-19-associated necrotizing encephalopathy presenting without active respiratory symptoms: a case report with histopathology
Creators: Leigh A Rettenmaier - Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, WACC 8-835, Boston, MA, USA. lrettenmaier@bwh.harvard.edu
Lama Abdel-Wahed - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Hisham Abdelmotilib - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Kyle S Conway - Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Nandakumar Narayanan - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Christopher L Groth - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Resource Type: Journal article
Publication Details: Journal of neurovirology, Vol.28(1), pp.172-176
DOI: 10.1007/s13365-021-01042-3
PMID: 34970720
PMCID: PMC8718039
ISSN: 1355-0284
eISSN: 1538-2443
Language: English
Date published: 12/30/2021
Academic Unit: Neurology; Pathology; Iowa Neuroscience Institute
Record Identifier: 9984210345302771

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