Case no 3
Patient no 3 is a 38 years old male who presented with complaints of fever and drowsiness for the last 4 days. He had no significant past medical history. He was having shortness of breath and chest pain from the last 12 days. On examination he had a fever of 101.3 F, blood pressure of 120/75 mm Hg, pulse rate of 96 bpm and respiratory rate of 18/min. He had a GCS 0f 10/15 and was not oriented in time place or person. He did not show any evidence of neck stiffness or any focal neurological deficit. His lab and upon suspected encephalitis spinal fluid was done whose reports are as follows in Table 3.
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. All common causes of encephalitis were ruled out through these lab investigations. His chest x ray was done which showed bilateral opacities and nasal swab COVID-19 Polymerase Chain Reaction (PCR) came out positive. He was suspected of having COVID-19 encephalitis so CSF COVID-19 Polymerase Chain Reaction (PCR) was also ordered but it came back negative. MRI brain was carried out which is given in