tetano
Editor, Senior Moderator
Cureus
. 2021 Feb 21;13(2):e13475.
doi: 10.7759/cureus.13475.
Posterior Reversible Encephalopathy Syndrome in a Patient With SARS-CoV-2 Infection Treated With Tocilizumab
Krishna Talluri[SUP] 1 2 [/SUP], Naveena Lall[SUP] 2 [/SUP], Marcos A Moreno[SUP] 2 [/SUP], Laura Nichols[SUP] 1 2 [/SUP], Dinesh Bande[SUP] 3 1 [/SUP]
Affiliations
Abstract
As the world has struggled to adapt to the coronavirus disease (COVID-19) pandemic, new evidence has emerged suggesting that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may manifest with a wide variety of neurologic symptoms. We present the case of a 70-year-old patient hospitalized for COVID-19 related pneumonia who was treated with off-label interleukin (IL)-6 inhibitor tocilizumab and eventually developed prolonged delirium. MRI findings were consistent with posterior reversible encephalopathy syndrome (PRES). PRES was felt to be from SARS-CoV-2 infection, tocilizumab, or a combination. The patient received symptomatic treatment without success. These findings are consistent with few other recent reports, which have chronicled PRES findings in patients with SARS-CoV-2 infections. However, this is only the second example of PRES in a COVID-19 patient treated with tocilizumab. While cases of PRES have been noted to occur with other infectious diseases, clinicians should be aware of the association with SARS-CoV-2 infection and tocilizumab therapy, particularly when considering tocilizumab treatment outside its approved indication. Future research efforts are needed to establish evidence-based guidelines for the management of these patients.
Keywords: case report; covid-19; pres; sars-cov-2; tocilizumab.
. 2021 Feb 21;13(2):e13475.
doi: 10.7759/cureus.13475.
Posterior Reversible Encephalopathy Syndrome in a Patient With SARS-CoV-2 Infection Treated With Tocilizumab
Krishna Talluri[SUP] 1 2 [/SUP], Naveena Lall[SUP] 2 [/SUP], Marcos A Moreno[SUP] 2 [/SUP], Laura Nichols[SUP] 1 2 [/SUP], Dinesh Bande[SUP] 3 1 [/SUP]
Affiliations
- PMID: 33777563
- PMCID: PMC7987818
- DOI: 10.7759/cureus.13475
Abstract
As the world has struggled to adapt to the coronavirus disease (COVID-19) pandemic, new evidence has emerged suggesting that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may manifest with a wide variety of neurologic symptoms. We present the case of a 70-year-old patient hospitalized for COVID-19 related pneumonia who was treated with off-label interleukin (IL)-6 inhibitor tocilizumab and eventually developed prolonged delirium. MRI findings were consistent with posterior reversible encephalopathy syndrome (PRES). PRES was felt to be from SARS-CoV-2 infection, tocilizumab, or a combination. The patient received symptomatic treatment without success. These findings are consistent with few other recent reports, which have chronicled PRES findings in patients with SARS-CoV-2 infections. However, this is only the second example of PRES in a COVID-19 patient treated with tocilizumab. While cases of PRES have been noted to occur with other infectious diseases, clinicians should be aware of the association with SARS-CoV-2 infection and tocilizumab therapy, particularly when considering tocilizumab treatment outside its approved indication. Future research efforts are needed to establish evidence-based guidelines for the management of these patients.
Keywords: case report; covid-19; pres; sars-cov-2; tocilizumab.