Steroid-responsive severe encephalopathy in SARS-CoV-2 infection

Andrea Pilotto; SIlvia Odolini; Stefano Masciocchi; Agnese Comelli; Irene Volonghi; Stefano Gazzina; Sara Nocivelli; Alessandro Pezzini; Emanuele Foca'; Arnaldo Caruso; Matilde Leonardi; Maria Pia Pasolini; Roberto Gasparotti; Francesco Castelli; Alessandro Padovani

The here described COVID-19 case is of particular interest, as the patients presented with severe encephalopathy with only mild respiratory alterations. Meningeal signs at presentation were suggestive for meningoencephalitis and the patient started combined antibiotic and antiviral treatment, according to current guidelines for CNS-infections 13 . Lack of presence of COVID-19 in two different CSF samples analyses could not definitely exclude the diffusion into the CNS, as viruses could enter in CSF and be cleared from it by the time of illness onset, such as in the case of West-Nile virus 14 . In our case, the blood brain barrier alterations supported by CSF analyses argue for a potential CNS invasion via blood route of COVID-19 3 . Of interest, peculiar akinetic mutism presentation has been associated with cases of Epstein-Barr encephalitis 15 . However, the normal MRI findings, with no meningeal enhancement or brain alterations, and the response to steroid treatment support other alternative pathophysiological mechanisms. In this case, we excluded the most common causes of autoimmune encephalitis, akinetic mutism and psychosis so far 16-18 . All rights reserved. No reuse allowed without permission. author/funder, who has granted medRxiv a license to display the preprint in perpetuity.