BMC Infectious Diseases (May 2022)

COVID-19-associated leukoencephalopathy in the absence of severe hypoxia with subsequent improvement: a case report

  • Hiroki Kojima,
  • Naoya Sakamoto,
  • Atsushi Kosaka,
  • Masayoshi Kobayashi,
  • Mitsuo Amemiya,
  • Takuya Washino,
  • Yusuke Kuwahara,
  • Takuto Ishida,
  • Mayu Hikone,
  • Satoshi Miike,
  • Tatsunori Oyabu,
  • Sentaro Iwabuchi,
  • Fukumi Nakamura-Uchiyama

DOI
https://doi.org/10.1186/s12879-022-07426-y
Journal volume & issue
Vol. 22, no. 1
pp. 1 – 5

Abstract

Read online

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