Case presentation
A 44-year-old female known case chronic bronchitis who was admitted by respiratory distress one months ago, and received Remdesivir by diagnosis of COVID-19 infection, after 10 days she discharged with clinical improvement. Twenty days after disease onset, the patient gradually developed memory loss and confusion, therefore, she admitted again. On examination she was confused without any focal neurological deficits, she did not have fever and meningeal irritation. Her pupils were isochoric and reactive and plantar reflex were down going. Brain CT showed severe hydrocephalus (figure 1). Brain MRI did not show any other pathologies. Lumbar puncture was done and CSF analysis revealed high protein, low glucose and pleocytosis (Table 1) and treatment with ceftriaxone (2gr/BD) and vancomycin (1gr/BD) got started and we continued the treatment. Due to severe hydrocephalus brain extra ventricular drainage was done for her. The EEG showed generalized slow activity. CSF evaluated for fungal, tuberculosis, brucellosis, sarcoidosis, and viral infections including HSV-1,2 and CMV, and autoimmune antibodies, and they came back positive for anti-GAD65 (Table 1). Malignancy and vasculitis work-up were negative. Due to the negative CSF culture, antibiotics discontinue and was started 7-day course of 1g/day IV methylprednisolone and she responded very well to medication and became conscious again and oriented without hallucination and illusion. Unfortunately, patient had pulmonary thromboembolism(PTE) in hospitalization and she died.