Case no 5
Patient no 2 is a 57 years old female who presented with complaints of
high grade fever and confusion from the last 2 days. She has a
background history of hypertension, asthma and well controlled diabetes.
She had sore throat and severe body aches from the last 10 days. On
examination she had a fever of 104.6 F, blood pressure of 125/75 mm Hg,
pulse rate of 98 bpm and a respiratory rate of 19/min. Her throat
examination showed red hyperemic throat. On her central nervous system
examination she was not oriented in time, place or person and had a GCS
of 10/15. She did not have any neck stiffness or any focal neurological
deficit. On chest examination she was having predominantly left sided
chest crepitations and bilateral expiratory wheezes. Her lab and upon
suspected encephalitis spinal fluid was done whose reports are as
follows in Table 5.
Autoimmune workup, including anti-N-methyl D-aspartate (NMDA) receptor
antibodies, anti-Ro antibodies, anti-La antibodies, antineutrophil
cytoplasmic antibodies (ANCA) antibodies, and anti-Hu antibodies, were
negative. These investigations were carried out to rule out the most
common and important causes of encephalitis and it came back negative.
As patient was having respiratory tract infection features as well so a
chest x ray was done which showed bilateral opacities more on the left
side. A nasal swab COVID-19 Polymerase Chain Reaction (PCR) was ordered
and it came back positive. The clinical picture pointed towards a
diagnosis of encephalitis so CSF COVID-19 Polymerase Chain Reaction
(PCR) was also ordered but it came back negative. Patient was suspected
of having COVID-19 encephalitis as all the other causes of encephalitis
have been ruled out. MRI brain was also done and is given in