tetano
Editor, Senior Moderator
BMC Infect Dis
. 2022 May 10;22(1):444.
doi: 10.1186/s12879-022-07426-y.
COVID-19-associated leukoencephalopathy in the absence of severe hypoxia with subsequent improvement: a case report
Hiroki Kojima[SUP] 1 [/SUP], Naoya Sakamoto[SUP] 2 [/SUP], Atsushi Kosaka[SUP] 2 [/SUP], Masayoshi Kobayashi[SUP] 3 [/SUP], Mitsuo Amemiya[SUP] 3 [/SUP], Takuya Washino[SUP] 2 [/SUP], Yusuke Kuwahara[SUP] 4 [/SUP], Takuto Ishida[SUP] 4 [/SUP], Mayu Hikone[SUP] 4 [/SUP], Satoshi Miike[SUP] 2 [/SUP], Tatsunori Oyabu[SUP] 2 [/SUP], Sentaro Iwabuchi[SUP] 2 [/SUP], Fukumi Nakamura-Uchiyama[SUP] 2 [/SUP]
Affiliations
Abstract
Background: Several cases of coronavirus disease 2019 (COVID-19)-associated leukoencephalopathy have been reported. Although most cases involve hypoxia, the pathophysiological mechanism and neurologic outcomes of COVID-19-associated leukoencephalopathy remain unclear.
Case presentation: We report a case of COVID-19-associated leukoencephalopathy without severe hypoxia in a 65-year-old woman diagnosed with pyelonephritis. After the initiation of intravenous ceftriaxone, her fever resolved, but she developed an altered state of consciousness with abnormal behavior and, subsequently, a relapse fever. She was diagnosed with COVID-19 pneumonia and was intubated. Lung-protective ventilation with deep sedation and neuromuscular blockade were used for treatment. After cessation of sedative administration, her mental status remained at a Glasgow Coma Scale score of 3. COVID-19 was assumed to have caused leukoencephalopathy due to the absence of severe hypoxia or other potential causes. She subsequently showed gradual neurologic improvement. Three months after the COVID-19 diagnosis, she regained alertness, with a Glasgow Coma Scale score of 15.
Conclusion: Clinicians should consider leukoencephalopathy in the differential diagnosis of consciousness disorders in patients with severe COVID-19, even in the absence of severe hypoxia. Gradual neurologic improvement can be expected in such cases.
Keywords: COVID-19; Hypoxia; Leukoencephalopathy; SARS-CoV-2.
. 2022 May 10;22(1):444.
doi: 10.1186/s12879-022-07426-y.
COVID-19-associated leukoencephalopathy in the absence of severe hypoxia with subsequent improvement: a case report
Hiroki Kojima[SUP] 1 [/SUP], Naoya Sakamoto[SUP] 2 [/SUP], Atsushi Kosaka[SUP] 2 [/SUP], Masayoshi Kobayashi[SUP] 3 [/SUP], Mitsuo Amemiya[SUP] 3 [/SUP], Takuya Washino[SUP] 2 [/SUP], Yusuke Kuwahara[SUP] 4 [/SUP], Takuto Ishida[SUP] 4 [/SUP], Mayu Hikone[SUP] 4 [/SUP], Satoshi Miike[SUP] 2 [/SUP], Tatsunori Oyabu[SUP] 2 [/SUP], Sentaro Iwabuchi[SUP] 2 [/SUP], Fukumi Nakamura-Uchiyama[SUP] 2 [/SUP]
Affiliations
- PMID: 35538434
- DOI: 10.1186/s12879-022-07426-y
Abstract
Background: Several cases of coronavirus disease 2019 (COVID-19)-associated leukoencephalopathy have been reported. Although most cases involve hypoxia, the pathophysiological mechanism and neurologic outcomes of COVID-19-associated leukoencephalopathy remain unclear.
Case presentation: We report a case of COVID-19-associated leukoencephalopathy without severe hypoxia in a 65-year-old woman diagnosed with pyelonephritis. After the initiation of intravenous ceftriaxone, her fever resolved, but she developed an altered state of consciousness with abnormal behavior and, subsequently, a relapse fever. She was diagnosed with COVID-19 pneumonia and was intubated. Lung-protective ventilation with deep sedation and neuromuscular blockade were used for treatment. After cessation of sedative administration, her mental status remained at a Glasgow Coma Scale score of 3. COVID-19 was assumed to have caused leukoencephalopathy due to the absence of severe hypoxia or other potential causes. She subsequently showed gradual neurologic improvement. Three months after the COVID-19 diagnosis, she regained alertness, with a Glasgow Coma Scale score of 15.
Conclusion: Clinicians should consider leukoencephalopathy in the differential diagnosis of consciousness disorders in patients with severe COVID-19, even in the absence of severe hypoxia. Gradual neurologic improvement can be expected in such cases.
Keywords: COVID-19; Hypoxia; Leukoencephalopathy; SARS-CoV-2.