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