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