An enigmatic case of central nervous system infection and superior sagittal sinus thrombosis in an adolescent with COVID-19

Abstract

COVID-19 neurological manifestations vary from mild symptoms, such as fatigue, to severe complications. This article presents a case of a 15-year-old male with multiple brain abscesses, meningitis, massive sinusitis and saggital sinus thrombosis. SARSCoV- 2 IgM and IgG antibodies were increased, while blood and CSF cultures, anti-HSV antibodies and IGRA were negative. The patient responded well to the initial treatment with broad-spectrum antibiotics, glucocorticoids and intravenous immunoglobulins. After two weeks, his clinical state sudd0enly collapsed, with the progression of purulent lesions in the MRI. Urgent craniotomy was performed. A follow-up MRI confirmed regression of the purulent lesions. Negative blood and CSF cultures, as well as insufficiency of the broad-spectrum antibiotic therapy, suggested an atypical or opportunistic CNS infection, characteristic of immunocompromised patients. This strengthens the hypothesis that SARS-CoV-2 infection may lead to decreased immunocompetence.

Keywords

• covid-19
• brain abscess
• subdural empyema
• superior sagittal sinus thrombosis