Acute Necrotizing Encephalitis as a Probable Association of COVID-19

Neeraj Kumar; Subhash Kumar; Abhyuday Kumar; Binod K Pati; Amarjeet Kumar; Chandramani Singh; Asim Sarfraz

doi:10.5005/jp-journals-10071-23636

Acute Necrotizing Encephalitis as a Probable Association of COVID-19

Indian J Crit Care Med. 2020 Oct;24(10):991-994. doi: 10.5005/jp-journals-10071-23636.

Authors

Neeraj Kumar¹, Subhash Kumar², Abhyuday Kumar³, Binod K Pati⁴, Amarjeet Kumar¹, Chandramani Singh⁵, Asim Sarfraz⁴

Affiliations

¹ Department of Trauma and Emergency, All India Institute of Medical Sciences, Patna, Bihar, India.
² Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, Bihar, India.
³ Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India.
⁴ Department of Microbiology, All India Institute of Medical Sciences, Patna, Bihar, India.
⁵ Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, Bihar, India.

Abstract

Background: Meanwhile, over 50 lakh people have now been affected by coronavirus disease-2019 (COVID-19) across the globe. There are various reports on neurological manifestations of COVID-19, which have attracted broad attention. Acute necrotizing encephalopathy (ANE) is a rare complication of influenza and other viral infections and has been related to intracranial cytokine storm, which results in breach in blood-brain barrier leading to encephalitis like presentation. We report an unusual case of acute necrotizing encephalitis as a solitary presentation of COVID-19.

Case description: We report a case of 35-year-old man from Bihar, presented to our emergency department in unconscious state, with high-grade fever and vomiting since last 5 days. Previous magnetic resonance imaging (MRI) brain showed a left parasellar-middle cranial fossa mass looks most likely like an invasive meningioma. Urgent noncontrast computed tomography scan (NCCT) brain showed that mass as well as hypodensities in both thalami and left caudate nucleus. As per our institutional protocol, clinical management of raised intracranial pressure was initiated. As there is no current evidence from any randomized control trails (RCTs) to recommend any specific treatment for suspected or confirmed patients with COVID-19 with acute necrotizing encephalitis.

Conclusion: Our case highlights the importance of identifying encephalitis as a presenting sign of COVID-19 based on NCCT findings with normal cerebrospinal fluid (CSF) and normal chest X-ray (CXR) findings.

How to cite this article: Kumar N, Kumar S, Kumar A, Pati BK, Kumar A, Singh C, et al. Acute Necrotizing Encephalitis as a Probable Association of COVID-19. Indian J Crit Care Med 2020;24(10):991-994.

Keywords: Acute necrotizing encephalitis; Altered sensorium; COVID case report; Computed tomography; Coronavirus disease-2019 in India; Encephalopathy; Magnetic resonance imaging.

Publication types

Case Reports