Department of Neurology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Japan.
Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Japan.
Intern Med. 2021 Oct 1;60(19):3167-3170. doi: 10.2169/internalmedicine.8123-21. Epub 2021 Aug 6.
We herein report a 49-year-old man with a fever, diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. After two weeks of hospitalization, he suddenly mentioned visual field impairment. Computed tomography and magnetic resonance imaging revealed white matter damage and vasogenic edema. Cerebrospinal fluid showed increased levels of interleukin (IL)-6. His symptoms and white matter lesion deteriorated. After treatment with intravenous methylprednisolone therapy and plasmapheresis, his symptoms and white matter lesion improved gradually. We suspect that our patient was affected by a secondary hyperinflammatory syndrome related to cytokines, alone or in combination with direct viral injury through endothelial cell damage. The IL-6 levels were elevated only in the cerebrospinal fluid, suggesting focal central nervous system inflammation.
我们在此报告一例 49 岁发热男性，诊断为严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染。住院两周后，他突然出现视野缺损。计算机断层扫描和磁共振成像显示白质损伤和血管源性水肿。脑脊液显示白细胞介素（IL）-6 水平升高。他的症状和白质病变恶化。静脉注射甲基强的松龙治疗和血浆置换后，他的症状和白质病变逐渐改善。我们怀疑我们的患者受到细胞因子相关的二次炎症过度活跃综合征的影响，单独或与通过内皮细胞损伤的直接病毒损伤相结合。IL-6 水平仅在脑脊液中升高，提示中枢神经系统炎症局灶性。
