COVID-19 encephalitis as a differential diagnosis of a Cyclosporine
related Posterior Leukoencephalopathy Syndrome (PRES)
Abstract
PRES is a rare neurological disease possibly associated with the use of
calcineurin inhibitors like cyclosporine A. Severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus, is responsible
for the outbreak of coronavirus disease 19 (COVID-19) and can cause
neurological manifestations. We describe a case of CSA-related PRES
whose diagnosis was difficult due to concurrent infection with
SARS-CoV-2. The 16-year-old patient was known to have
corticosteroid-resistant nephrotic syndrome secondary to minimal change
disease. CSA was therefore introduced and on the fifth day of treatment,
he presented with seizures followed by fever. Biological and MRI data
were in favor of SARS-CoV-2 encephalitis. Relief of immunosuppression by
discontinuation of CSA was decided and the patient was put on
anticonvulsants. After being declared cured of COVID-19, which was
without other clinical signs, the CSA was reintroduced but the patient
presented with seizures the next day. This allowed us to rectify the
diagnosis and relate the seizures to a CSA-related PRES. We concluded
that infection with SARS-CoV-2 could be a differential diagnosis of a
PRES related to anticalcineurins.