Neurological Complications during Treatment of Middle East Respiratory Syndrome

Kim, Jee-Eun; Heo, Jae-Hyeok; Kim, Hye-ok; Song, Sook-hee; Park, Sang-Soon; Park, Tai-Hwan; Ahn, Jin-Young; Kim, Min-Ky; Choi, Jae-Phil

Since the first case of Middle East respiratory syndrome (MERS) was reported in Saudi Arabia in 2012, 1,826 laboratory-confirmed cases have been documented in 27 countries, and 35.5% of these patients have died from this novel virus. 1,2 In May 2015, the Republic of Korea suffered the largest outbreak of MERS outside of the Middle East, in which 186 patients were infected and 38 deaths were confirmed. 3 Patients with MERS-coronavirus (CoV) infections typically exhibit fever, myalgia, cough, and dyspnea, which typically proceed to pneumonia. Although some infections are asymptomatic, many cases present with severe symptoms that can result in acute respiratory distress syndrome (ARDS), septic shock, multiorgan failure, and death. 4 MERS-CoV is in the Betacoronavirus genus, whose species are known to be potentially neuroinvasive. 5 However, very little information is currently available on the neurological manifestations of MERS and their incidence rates. A retrospective study in Saudi Arabia found that 25.7% of MERS patients developed confusion and 8.6% experienced a seizure. 6 Only four cases with central nervous system involvement (acute disseminated encephalomyelitis, stroke, and encephali-Jee-Eun Kim a Jae-Hyeok Heo a Hye-ok Kim b Sook-hee Song b Sang-Soon Park a Tai-Hwan Park a Jin-Young Ahn a Min-Ky Kim a Jae-Phil Choi c JCN tis) and one case with critical-illness polyneuropathy have been reported for patients with MERS. 7, 8 Here we describe four patients with neurological manifestations that developed while they were being treated for MERS at a single hospital designated to treat MERS during the 2015 outbreak in the Republic of Korea.