Georgousi Kleoniki, Karageorgiou Panagiotis, Tzaki Maria, Pachi Ioanna, Kyriazis Ioannis
Internal Medicine/Infectious Diseases, KAT Attica General Hospital, Kifissia, GRC.
Internal Medicine, KAT Attica General Hospital, Kifissia, GRC.
Cureus. 2023 Mar 31;15(3):e36959. doi: 10.7759/cureus.36959. eCollection 2023 Mar.
A 58-year-old man was admitted to the hospital with acute neurological manifestations of encephalitis 15 days after a previous upper respiratory COVID-19 illness. On presentation, he was confused with altered mental status, aggressive behavior, and a Glasgow coma scale score of 10/15. Laboratory investigation, brain computed tomography (CT), and brain magnetic resonance imaging (MRI) were unremarkable with normal results. Although the cerebrospinal fluid (CSF) polymerase chain reaction (PCR) for SARS-CoV-2 was negative, we found increased concentrations of positive immunoglobulin (Ig) A and IgG antibodies in CSF, suggesting acute central nervous system (CNS) infection and indirect confirmation of virus neuroinvasion. There was no evidence of humoral auto-reactivity, and we rejected the hypothesis of autoimmune encephalitis with known autoantibodies. On the fifth day of hospitalization, myoclonic jerks emerged as a new neurological sign until the added levetiracetam led to total remission. The patient achieved full recovery after antiviral and corticosteroid therapy implementation of 10 days in the hospital. This case report emphasizes the importance of the presence of CSF IgA and IgG antibodies to diagnose encephalitis in COVID-19 patients as an indirect confirmation of CNS infection.
一名58岁男性在先前感染新型冠状病毒肺炎（COVID-19）导致上呼吸道疾病15天后，因脑炎的急性神经症状入院。就诊时，他意识模糊，精神状态改变，有攻击行为，格拉斯哥昏迷量表评分为10/15。实验室检查、脑部计算机断层扫描（CT）和脑部磁共振成像（MRI）结果均无异常。虽然脑脊液（CSF）中严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的聚合酶链反应（PCR）检测结果为阴性，但我们发现脑脊液中阳性免疫球蛋白（Ig）A和IgG抗体浓度升高，提示存在急性中枢神经系统（CNS）感染，并间接证实病毒神经侵袭。没有体液自身反应性的证据，我们排除了已知自身抗体所致自身免疫性脑炎的假设。住院第5天，肌阵挛性抽搐作为一种新的神经症状出现，直到加用左乙拉西坦后完全缓解。该患者在住院接受10天抗病毒和皮质类固醇治疗后完全康复。本病例报告强调了脑脊液中IgA和IgG抗体在诊断COVID-19患者脑炎中的重要性，可作为中枢神经系统感染的间接证据。
