COVID‐19 meningitis without pulmonary involvement with positive cerebrospinal fluid PCR
Abstract
Background: Coronavirus disease 2019 (COVID‐19) typically presents with respiratory illness ranging in severity. Neurological complications of the disease remain largely unknown. Herein, we discuss the case of a woman diagnosed with COVID‐19 meningitis following two positive cerebrospinal fluid (CSF) RT‐PCR assays, and highlight the importance of recognizing the neurological manifestations of the disease. Case report: The patient was a 49‐year‐old woman with a history of hypertension who presented with non‐specific symptoms (fever, headache, malaise, nausea/vomiting). Chest computed tomography (CT) revealed a lack of pulmonary involvement and oropharyngeal/nasopharyngeal RT‐PCR was negative for COVID‐19. A lumbar puncture was performed on the third day of admission and the CSF analysis elucidated a viral pattern, but the CSF bacterial culture and RT‐PCR assay for herpes simplex virus were both negative. Surprisingly, the CSF RT‐PCR for COVID‐19 was positive. The diagnosis of COVID‐19 meningitis was made and the patient was treated solely with Kaletra®, with a second CSF analysis confirming our unique finding 1 week later. The patient's clinical characteristics improved progressively, and she was discharged in excellent general condition after 21 days. Conclusion: In contrast to what was originally believed, the SARS‐CoV‐2 can cause meningitis in isolation, perhaps by crossing the blood‐brain barrier. Hence, it seems essential that physicians maintain a high index of suspicion for neurological involvement among COVID‐19 patients, with early CSF analysis and brain imaging sometimes being indicated.
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SARS-CoV-2 has been found in neural and endothelial cells in frontal lobe tissues and in the cerebral spinal fluid of infected individuals.
“This observation was corroborated by the finding of the virus in neural and endothelial cells in frontal lobe tissues [154], and in the cerebral spinal fluid of infected individuals [147, 155, 156].”
From Cognitive decline following acute viral infections: literature review and projections for post-COVID-19 (2022) · cites this paper as [156]
Cites
Clinical characteristics of coronavirus disease 2019 in China
Guan, W.-J., Ni, Z.-Y., Hu, Y., Liang, W.-H., Ou, C.-Q., He, J.-X., Liu, L., Shan, H., Lei, C.-L., Hui, D. S. C., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmoa2002032 · Cited by 30,246 · see citing works
Wang, D., Hu, B., Hu, C., Zhu, F., Liu, X., Zhang, J., Wang, B., Xiang, H., Cheng, Z., Xiong, Y., et al. (2020) · JAMA · doi:10.1001/jama.2020.1585 · Cited by 20,148 · see citing works
La certeza de lo impredecible: Cultura Educación y Sociedad en tiempos de COVID19
Martínez González, M. (2020) · DSPACE System - Metalibrary (University of the Coast) · Cited by 18,463 · see citing works
Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China
Mao, L., Jin, H., Wang, M., Hu, Y., Chen, S., He, Q., Chang, J., Hong, C., Zhou, Y., Wang, D., et al. (2020) · JAMA Neurology · doi:10.1001/jamaneurol.2020.1127 · Cited by 7,166 · see citing works
COVID-19: Gastrointestinal Manifestations and Potential Fecal–Oral Transmission
Gu, J., Han, B., & Wang, J. (2020) · Gastroenterology · doi:10.1053/j.gastro.2020.02.054 · Cited by 1,505 · see citing works
Multiple organ infection and the pathogenesis of SARS
Gu, J., Gong, E., Zhang, B., Zheng, J., Gao, Z., Zhong, Y., Zou, W., Zhan, J., Wang, S., Xie, Z., et al. (2005) · The Journal of Experimental Medicine · doi:10.1084/jem.20050828 · Cited by 1,379 · see citing works
Neurological Complications of Coronavirus Disease (COVID-19): Encephalopathy
Filatov, A., Sharma, P., Hindi, F., & Espinosa, P. S. (2020) · Cureus · doi:10.7759/cureus.7352 · Cited by 671 · see citing works
Saad, M., Omrani, A. S., Baig, K., Bahloul, A., Elzein, F., Matin, M. A., Selim, M. A. A., Mutairi, M. A., Nakhli, D. A., Aidaroos, A. Y. A., et al. (2014) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2014.09.003 · Cited by 486 · see citing works
Neurological Implications of COVID-19 Infections
Needham, E., Chou, S., Coles, A. J., & Menon, D. K. (2020) · Neurocritical Care · doi:10.1007/s12028-020-00978-4 · Cited by 237 · see citing works
Shahriarirad, R., Khodamoradi, Z., Erfani, A., Hosseinpour, H., Ranjbar, K., Emami, Y., Mirahmadizadeh, A., Lotfi, M., Yeganeh, B. S., Nejad, A. D., et al. (2020) · BMC Infectious Diseases · doi:10.1186/s12879-020-05128-x · Cited by 178 · see citing works
Self-citationCo-infection of Coronavirus Disease 2019 and Influenza A: A Report from Iran
Khodamoradi, Z., Moghadami, M., & Lotfi, M. (2020) · Archives of Iranian Medicine · doi:10.34172/aim.2020.04 · Cited by 108 · see citing works
Self-citationEspinosa, P. S., Rizvi, Z., Sharma, P., et al. (2020) · Cureus · doi:10.7759/cureus.7930 · Cited by 86 · see citing works
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Damiano, R. F., Guedes, B. F., de Rocca, C. C., de Pádua Serafim, A., Castro, L. H. M., Munhoz, C. D., Nitrini, R., Filho, G. B., Miguel, E. C., Lucchetti, G., et al. (2022) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-021-01286-4 · Cited by 98 · see citing works
- Authors
- Khodamoradi, Z., Hosseini, S. A., Gholampoor Saadi, M. H., Mehrabi, Z., Sasani, M. R., & Yaghoubi, S.
- Affiliations
- Shiraz University of Medical Sciences (IR)
- Shiraz University of Medical Sciences Shiraz Iran
- Corresponding author
- Yaghoubi, S.
- Venue
- European Journal of Neurology
- Publisher
- Wiley
- Published
- 2020-11-08
- Volume
- 27
- Issue
- 12
- Pages
- 2668-2669
- ISSN
- 1351-5101 (ISSN-L)
- 1468-1331
- OpenAlex
- W3084550572
- Cited by
- 41
- References
- 12
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 6 · 2022: 11 · 2021: 19 · 2020: 1
- FWCI
- 4.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Neurology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Keywords
- COVID-19 pandemic, SARS-CoV-2, meningitis, neurological complications, blood-brain barrier, lumbar puncture, antiretroviral therapy, viral meningitis
- MeSH terms
- COVID-19, Blood-Brain Barrier, Female, Humans, Meningitis, Viral, Middle Aged, Tomography, X-Ray Computed, Polymerase Chain Reaction, Treatment Outcome
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