Abstract Details

Title Autoimmune encephalitis following recovery of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection

Topic Autoimmune Neurology

Presentation(s) Autoimmune Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 007

Objective

The novel SARS-CoV-2 predominantly presents with respiratory symptoms. Neurological complications of coronavirus disease 2019 (COVID-19) have been reported including but not limited to encephalopathy, stroke, seizures, meningoencephalitis, GBS, ADEM and myalgias. However, post-infectious COVID-19 autoimmune encephalitis has not been reported. Here, we report a case of post-COVID-19 autoimmune encephalitis.

Background A 60-year-old male physician with a history of recent recovered COVID-19 infection presented with neuropsychiatric complaints including altered mental status, perseveration, disinhibition, word finding difficulty and worsening paranoia. Exam consistent with constructional apraxia, akinetic mutism, bradykinesia, severely impaired delayed recall, and difficulty with complex tasks and multistep commands. Other neurological exam was normal. Cerebrospinal fluid analysis (CSF) demonstrated a glucose of 58, protein of 54, nucleated cell count of 0, RBC 0. SARS-CoV-2 RT-PCR in CSF was inconclusive. Autoimmune encephalitis and paraneoplastic panel in CSF were negative. Positron emission tomography (PET) scan was consistent with abnormal mixed brain hypometabolism and hypermetabolism suggesting an early pattern of autoimmune encephalitis. Detailed neurocognitive testing consistent with severe executive dysfunction. 48 hours of video EEG was suggestive of severe diffuse encephalopathy, no seizures or epileptiform discharges. Patient received treatment with 5 days of intravenous immunoglobulin (IVIg) with marked improvement noted clinically and as well as on repeat PET imaging and neurocognitive testing.

Design/Methods NA

Results NA

Conclusions

SARS-CoV-2 infection is associated with respiratory symptoms and complications. There should be high suspicion of autoimmune encephalitis following COVID-19 infection in patients presenting with combination of neurological and neuropsychiatric symptoms following recovery of acute infection. PET scan can be abnormal initially in the autoimmune encephalitis, when EEG, MRI, and CSF studies are in-conclusive. Treatment with IVIg is warranted and clinical improvement can be monitored with pre and post treatment repeat imaging and neuro-cognitive testing. Future studies to understand post COVID autoimmune encephalitis are warranted.

Authors/Disclosures
Fawad Yousuf, MBBS PRESENTER	Dr. Yousuf has nothing to disclose.
Richard D. King, MD, PhD, FAAN (University of Kentucky Neurology Dept)	Dr. King has nothing to disclose.
Timothy J. Ainger, PhD (University of Kentucky College of Medicine, Dept. of Neurology)	Dr. Ainger has nothing to disclose.
Amy Hessler, DO, FAAN	Dr. Hessler has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Abbvie . Dr. Hessler has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Lundbeck . Dr. Hessler has received publishing royalties from a publication relating to health care.

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