Darvishnia David, Ahmadi Hanieh, Sanei Motlagh Alireza
Department of Infectious Diseases, Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
Department of Ophthalmology, School of Medicine, Sari Bu Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran.
Tanaffos. 2022 Feb;21(2):257-260.
The SARS-CoV-2 invades the cells by attachment of virus spike proteins (S1, S2) to cell membrane and engages angiotensin-converting enzyme 2 (ACE2), which is highly expressed in the epithelium of cerebral vasculature. Here, we describe a patient with encephalitis following SARS-CoV-2 infection.
A 77-year-old male patient presented with mild cough and coryza lasting for eight days without a prior history of underlying disease or neurologic disorder. Oxygen saturation (SatO) was decreased and behavioral changes, confusion, and headaches were started within three days prior to admission. Bilateral ground glass opacifications and consolidations were noted on chest CT scan. Lymphopenia, highly elevated D-Dimer and ferritin were noted in laboratory results. Brain CT and MRI showed no changes regarding encephalitis. Cerebrospinal fluid was collected as the symptoms persisted. The results of SARS-CoV-2 RNA RT-PCR from CSF and nasopharyngeal samples were positive. The combination therapy with remdesivir, interferon beta-1alpha and methylprednisolone was started. Due to deterioration of the patient's status and SatO he was admitted to the ICU and intubated. Tocilizumab, dexamethasone, and mannitol were started. The patient was extubated on the 16th day of ICU admission. The patient's level of consciousness and SatO were improved. He was discharged from the hospital a week later.
RT-PCR of CSF sample along with brain imaging can help with diagnosis when encephalitis due to SARS-CoV-2 is suspected. However, no changes regarding encephalitis may be seen on brain CT or MRI. Combination therapy with antivirals, interferon beta, corticosteroids, and tocilizumab can help patients recover in these conditions.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）通过病毒刺突蛋白（S1、S2）与细胞膜结合侵入细胞，并与血管紧张素转换酶2（ACE2）结合，ACE2在脑血管上皮中高表达。在此，我们描述1例SARS-CoV-2感染后发生脑炎的患者。
1例77岁男性患者，出现轻度咳嗽和鼻塞，持续8天，既往无基础疾病或神经系统疾病史。入院前3天内出现氧饱和度（SatO）下降以及行为改变、意识模糊和头痛。胸部CT扫描显示双侧磨玻璃影和实变。实验室检查结果显示淋巴细胞减少、D-二聚体和铁蛋白显著升高。脑部CT和MRI检查未发现与脑炎相关的改变。由于症状持续存在，进行了脑脊液采集。脑脊液和鼻咽部样本的SARS-CoV-2 RNA逆转录聚合酶链反应（RT-PCR）结果呈阳性。开始使用瑞德西韦、干扰素β-1α和甲泼尼龙联合治疗。由于患者病情恶化和SatO下降，转入重症监护病房（ICU）并进行气管插管。开始使用托珠单抗、地塞米松和甘露醇治疗。患者在入住ICU第16天拔管。患者意识水平和SatO得到改善。1周后出院。
当怀疑SARS-CoV-2引起脑炎时，脑脊液样本的RT-PCR检查以及脑部影像学检查有助于诊断。然而，脑部CT或MRI可能未发现与脑炎相关的改变。抗病毒药物、干扰素β、皮质类固醇和托珠单抗联合治疗可帮助此类患者康复。
