COVID-19-associated immune-mediated encephalitis mimicking acute-onset Creutzfeldt-Jakob disease.
Simone BerettaAndrea StabileClaudia BalducciDiFrancesco Jacopo CosimoAdriana PatrunoRoberto RonaMichela BombinoCristina CapraroFrancesca AndreettaPaola CavalcanteFabio ModaGiuseppe CiterioGiuseppe FotiGraziella BogliunCarlo FerraresePublished in: Annals of clinical and translational neurology (2021)
We report a subtype of immune-mediated encephalitis associated with COVID-19, which closely mimics acute-onset sporadic Creutzfeldt-Jakob disease. A 64-year-old man presented with confusion, aphasia, myoclonus, and a silent interstitial pneumonia. He tested positive for SARS-CoV-2. Cognition and myoclonus rapidly deteriorated, EEG evolved to generalized periodic discharges and brain MRI showed multiple cortical DWI hyperintensities. CSF analysis was normal, except for a positive 14-3-3 protein. RT-QuIC analysis was negative. High levels of pro-inflammatory cytokines were present in the CSF and serum. Treatment with steroids and intravenous immunoglobulins produced EEG and clinical improvement, with a good neurological outcome at a 6-month follow-up.
Keyphrases
- sars cov
- coronavirus disease
- resting state
- respiratory failure
- functional connectivity
- respiratory syndrome coronavirus
- working memory
- white matter
- magnetic resonance imaging
- drug induced
- multiple sclerosis
- low dose
- small molecule
- late onset
- mild cognitive impairment
- high dose
- acute respiratory distress syndrome
- extracorporeal membrane oxygenation