Kamel Tony, Toppen William, Salahmand Yasaman
Department of Internal Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, USA.
Department of Internal Medicine, University of California San Diego (UCSD) Health, San Diego, USA.
Cureus. 2025 May 31;17(5):e85150. doi: 10.7759/cureus.85150. eCollection 2025 May.
In December 2021, a 58-year-old unvaccinated woman with a past medical history of obesity presented to an outside hospital with severe coronavirus disease 2019 (COVID-19) pneumonia requiring intubation and a prolonged ICU stay. Although she eventually recovered and was extubated, she continued to experience persistent generalized weakness, nausea, weight loss, and mental status changes following discharge. In March 2022, she required re-hospitalization for altered mental status. Her condition progressively deteriorated, rendering her obtunded and nonverbal, responding only to noxious stimuli. After an extensive but unremarkable infectious, neurological, and hematologic workup, she was transferred to our facility for a higher level of care. Post-COVID-19 autoimmune encephalitis was suspected. Despite a trial of intravenous steroids, she remained largely nonverbal, producing only occasional single-word utterances. Following treatment with plasmapheresis, she demonstrated remarkable improvement, speaking in near-complete sentences just one day later and gradually recovering thereafter. It had previously been unclear whether plasmapheresis could serve as an effective treatment for post-COVID-19 encephalitis. We present a case of severe encephalopathy due to post-COVID-19 encephalitis that was successfully treated with plasmapheresis after failure of steroid therapy.
2021年12月，一名58岁未接种疫苗、有肥胖病史的女性因严重的2019冠状病毒病（COVID-19）肺炎被送往一家外部医院，需要插管并在重症监护病房长期住院。尽管她最终康复并拔管，但出院后仍持续存在全身无力、恶心、体重减轻和精神状态改变的症状。2022年3月，她因精神状态改变再次住院。她的病情逐渐恶化，变得昏迷且无法言语，仅对有害刺激有反应。在进行了广泛但无异常发现的感染、神经和血液学检查后，她被转至我们的机构接受更高水平的治疗。怀疑为COVID-19后自身免疫性脑炎。尽管试用了静脉注射类固醇，但她仍基本无法言语，仅偶尔说出单个单词。在进行血浆置换治疗后，她有了显著改善，一天后就能用近乎完整的句子说话，此后逐渐康复。此前尚不清楚血浆置换是否可作为COVID-19后脑炎的有效治疗方法。我们报告一例因COVID-19后脑炎导致的严重脑病，在类固醇治疗失败后成功通过血浆置换治愈。
