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LETTER TO EDITOR Table of Contents  
Ahead of print publication
Acute hemorrhagic leukoencephalitis in COVID-19 infection


 Department of General Medicine, Nizar Hospital, Valanchery, Kerala, India

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Date of Submission10-Jun-2022
Date of Decision20-Jun-2022
Date of Acceptance25-Jun-2022
Date of Web Publication18-Oct-2022
 


How to cite this URL:
Abdulla MC. Acute hemorrhagic leukoencephalitis in COVID-19 infection. Indian J Med Spec [Epub ahead of print] [cited 2022 Dec 5]. Available from: http://www.ijms.in/preprintarticle.asp?id=358779




Dear Editor,

A 60-year-old woman presented with altered mental status for 1 day. She was admitted in an outside hospital with fever, dry cough, and fatigue 2 weeks back. She was diagnosed to have COVID-19 (nasal swab reverse transcriptase-polymerase positive) and was discharged after 1 week of hospital stay. She had type 2 diabetes and systemic hypertension for 5 years. Examination on admission showed Glasgow Coma Score 7/15 (E2V1M4), and there was a paucity of movements on the right side.

Magnetic resonance imaging of the brain showed areas of T2 and fluid attenuation inversion recovery hyperintensities involving the subcortical deep white matter and cortex in the bilateral frontoparietal, right temporal, and left occipital areas and right cerebellum. Susceptibility-weighted images showed punctate hemorrhages in the bilateral frontoparietal regions. Diffusion-weighted imaging demonstrated only limited areas of restricted diffusion. Postcontrast images showed areas of enhancement involving cortical and subcortical regions in few areas [Figure 1]. Three-dimensional time-of-flight magnetic resonance angiography and magnetic resonance venogram were normal. These findings suggested a diagnosis of acute hemorrhagic leukoencephalitis (AHLE). Cerebrospinal fluid showed lymphocytic pleocytosis with increased protein. She was treated with methylprednisolone 1 g daily and antiedema measures. The patient showed no improvement and was not willing for any further treatment.
Figure 1: Magnetic resonance imaging of the brain showing areas of T2 and fluid attenuation inversion recovery hyperintensities involving the subcortical deep white matter and cortex in the bilateral frontoparietal, right temporal, and left occipital areas and right cerebellum (a-d). Susceptibility-weighted images showing punctate hemorrhages in bilateral frontoparietal regions (e and f). Diffusion-weighted imaging (g-i) and corresponding apparent diffusion coefficient maps (j-l) showing limited areas of restricted diffusion

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Neurological manifestations in COVID-19 are considered secondary to direct viral cytopathic effect on neurons, immune-mediated inflammation, and development of intracranial cytokine storm.[1] AHLE is a rare monophasic demyelinating and severe form of acute disseminated encephalomyelitis with poor prognosis.[2] The case reminds the readers of an extremely rare complication of an on-going pandemic.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

None.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Perrin P, Collongues N, Baloglu S, Bedo D, Bassand X, Lavaux T, et al. Cytokine release syndrome-associated encephalopathy in patients with COVID-19. Eur J Neurol 2021;28:248-58.  Back to cited text no. 1
    
2.
Varadan B, Shankar A, Rajakumar A, Subramanian S, Sathya AC, Hakeem AR, et al. Acute hemorrhagic leukoencephalitis in a COVID-19 patient – A case report with literature review. Neuroradiology 2021;63:653-61.  Back to cited text no. 2
    

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Correspondence Address:
Mansoor C Abdulla,
Department of General Medicine, Nizar Hospital, Valanchery, Kerala
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/injms.injms_71_22



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