Post-infectious focal encephalitis due to COVID-19.

Fukushima, Elisa Fumi Akagi; Nasser, Abdulla; Bhargava, Ashish; Moudgil, Shyam

Introduction Several publications described neurological manifestations caused by SARS-CoV-2. Immune-mediated neurological damages caused by COVID-19 are increasingly recognized. Case report A young male presented in March 2020 with a new-onset seizure. Later, he started to experience a severe headache. During the second admission in May, the MRI of the brain showed left frontal lesion. Nasal PCR for SARS-CoV-2 was negative, but the serology was positive, raising the suspicion of immune-mediated encephalitis. Elevated cerebrospinal fluid immunoglobulin G with two oligoclonal bands were also seen. The patient received IV immunoglobulin and showed improvement in headache. Follow-up MRIs of the brain revealed complete resolution of the lesion. Discussion Neurological complications from COVID-19 have been increasingly recognized. The proposed pathophysiology is either direct damage of neurological tissues, or indirectly through immune-mediated mechanisms. The timeline of the patient's presentation with seizure, as well as the lesion on the brain MRI with complete resolution after the IV immunoglobulin, strongly suggest that the patient had immune-mediated encephalitis after exposure to SARS-CoV-2. Conclusions Several cases of encephalitis caused by SARS-CoV-2 have been reported. Immune-mediated encephalitis as probable pathophysiology is described here.