Ananthegowda Dore C, Khatib Mohamad Y, Ali Husain S, Al Wraidat Mohamed, Imam Yahia
Medical Intensive Care Unit, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar.
Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar.
IDCases. 2021;26:e01346. doi: 10.1016/j.idcr.2021.e01346. Epub 2021 Nov 23.
The use of steroids and other immune modulatory therapies in the treatment of severe COVID-19 pneumonia predisposes patients to the reemergence of opportunistic infections. (CMV) reactivation can be one of them. A 55-year-old gentleman with severe COVID-19 pneumonia and hypoxic respiratory failure who was ventilated and received steroids but no other immunomodulatory drugs; had altered sensorium and multiple episodes of seizures in the later course of his illness. Brain MRI showed leptomeningeal enhancement and encephalopathy changes, electroencephalography (EEG) was suggestive of diffuse encephalopathy and his cerebrospinal fluid (CSF) analysis revealed high Cytomegalovirus PCR DNA titers (103,614). The patient made a complete recovery after treatment with Ganciclovir. Altered sensorium in cases of COVID-19 can be multifactorial. High index of suspicion for reactivation of dormant infections is warranted. CMV meningoencephalitis is one of the differential diagnoses. We believe this is the first case reported of CMV meningoencephalitis in the setting of severe COVID-19 infection.
在重症新型冠状病毒肺炎（COVID-19）的治疗中使用类固醇和其他免疫调节疗法会使患者易发生机会性感染的复发。巨细胞病毒（CMV）再激活可能是其中之一。一名55岁患有重症COVID-19肺炎和低氧性呼吸衰竭的男性患者，接受了机械通气并使用了类固醇，但未使用其他免疫调节药物；在疾病后期出现意识改变和多次癫痫发作。脑部磁共振成像（MRI）显示软脑膜强化和脑病改变，脑电图（EEG）提示弥漫性脑病，其脑脊液（CSF）分析显示巨细胞病毒聚合酶链反应（PCR）DNA滴度很高（103,614）。该患者在接受更昔洛韦治疗后完全康复。COVID-19病例中的意识改变可能是多因素的。对于潜伏感染再激活需要有高度的怀疑指数。CMV脑膜脑炎是鉴别诊断之一。我们认为这是首例在重症COVID-19感染背景下报告的CMV脑膜脑炎病例。
