Case no 1
Patient no 1 is a 48 years old male who presented with complaints of fever, confusion and one episode of seizure since the last 3 days. Patient had been suffering from sore throat, cough and shortness of breath from the last 12 days. He did not have any significant past medical history. He did not have any previous history of seizures before. On arrival he was having a fever of 103 F, blood pressure of 120/75 mm Hg, pulse of 103 bpm and a respiratory rate of 16/min. On examination he was not oriented in time place or person and his GCS score was 11/15. There was no neck stiffness or any focal neurological deficit. On chest auscultation there were bilateral crepitations as well. His lab and upon suspected encephalitis spinal fluid was done whose reports are as follows in Table1.
This lumbar puncture report presented a diagnostic dilemma as all the common causes of encephalitis were ruled out. 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. As patient was having respiratory symptoms as well, a chest X-ray was ordered which showed bilateral homogenous peripheral shadows. A nasal swab COVID-19 Polymerase Chain Reaction (PCR) was ordered and it came back positive. Patient was suspected of having COVID-19 related encephalitis so a CSF COVID-19 Polymerase Chain Reaction (PCR) was done but it came back negative. MRI brain was also carried out which is given in