COVID-19-associated leukoencephalopathy in the absence of severe hypoxia with subsequent improvement: a case report
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 re...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-05-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-022-07426-y |
| _version_ | 1818202126251196416 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Hiroki Kojima |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-12T03:04:29Z |
| format | Article |
| id | doaj.art-16585ce753104e30956052ae3ac0e91f |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-12T03:04:29Z |
| publishDate | 2022-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-16585ce753104e30956052ae3ac0e91f2022-12-22T00:40:32ZengBMCBMC Infectious Diseases1471-23342022-05-012211510.1186/s12879-022-07426-yCOVID-19-associated leukoencephalopathy in the absence of severe hypoxia with subsequent improvement: a case reportHiroki Kojima0Naoya Sakamoto1Atsushi Kosaka2Masayoshi Kobayashi3Mitsuo Amemiya4Takuya Washino5Yusuke Kuwahara6Takuto Ishida7Mayu Hikone8Satoshi Miike9Tatsunori Oyabu10Sentaro Iwabuchi11Fukumi Nakamura-Uchiyama12Department of Infectious Diseases, Tokyo Metropolitan Bokutoh HospitalDepartment of Infectious Diseases, Tokyo Metropolitan Bokutoh HospitalDepartment of Infectious Diseases, Tokyo Metropolitan Bokutoh HospitalDepartment of Respiratory Medicine, Tokyo Metropolitan Bokutoh HospitalDepartment of Respiratory Medicine, Tokyo Metropolitan Bokutoh HospitalDepartment of Infectious Diseases, Tokyo Metropolitan Bokutoh HospitalTertiary Emergency Medical Center (Trauma and Critical Care), Tokyo Metropolitan Bokutoh HospitalTertiary Emergency Medical Center (Trauma and Critical Care), Tokyo Metropolitan Bokutoh HospitalTertiary Emergency Medical Center (Trauma and Critical Care), Tokyo Metropolitan Bokutoh HospitalDepartment of Infectious Diseases, Tokyo Metropolitan Bokutoh HospitalDepartment of Infectious Diseases, Tokyo Metropolitan Bokutoh HospitalDepartment of Infectious Diseases, Tokyo Metropolitan Bokutoh HospitalDepartment of Infectious Diseases, Tokyo Metropolitan Bokutoh HospitalAbstract 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.https://doi.org/10.1186/s12879-022-07426-yLeukoencephalopathyHypoxiaCOVID-19SARS-CoV-2 |
| spellingShingle | 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 COVID-19-associated leukoencephalopathy in the absence of severe hypoxia with subsequent improvement: a case report BMC Infectious Diseases Leukoencephalopathy Hypoxia COVID-19 SARS-CoV-2 |
| title | COVID-19-associated leukoencephalopathy in the absence of severe hypoxia with subsequent improvement: a case report |
| title_full | COVID-19-associated leukoencephalopathy in the absence of severe hypoxia with subsequent improvement: a case report |
| title_fullStr | COVID-19-associated leukoencephalopathy in the absence of severe hypoxia with subsequent improvement: a case report |
| title_full_unstemmed | COVID-19-associated leukoencephalopathy in the absence of severe hypoxia with subsequent improvement: a case report |
| title_short | COVID-19-associated leukoencephalopathy in the absence of severe hypoxia with subsequent improvement: a case report |
| title_sort | covid 19 associated leukoencephalopathy in the absence of severe hypoxia with subsequent improvement a case report |
| topic | Leukoencephalopathy Hypoxia COVID-19 SARS-CoV-2 |
| url | https://doi.org/10.1186/s12879-022-07426-y |
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