Encephalopathy and Encephalitis Associated with Cerebrospinal Fluid Cytokine Alterations and Coronavirus Disease, Atlanta, Georgia, USA, 2020

• DOI: 10.3201/eid2609.202122
• Publication Date: 2020-06-02T19:16:10Z
• Authors: Karima Benameur; Ankita Agarwal; Sara C. Auld; Matthew P. Butters; Andrew S. Webster; Tugba Ozturk; J. Christina Howell; Leda C. Bassit; Alvaro Velasquez; Raymond F. Schinazi; Mark E. Mullins; William T. Hu
• Keywords: Adult; Male; Georgia; coronaviruses; SARA-CoV-2; Pneumonia, Viral; Infectious and parasitic diseases; RC109-216; Betacoronavirus; 03 medical and health sciences; Fatal Outcome; 0302 clinical medicine; Humans; viruses; Encephalitis, Viral; Pandemics; Brain Diseases; SARS-CoV-2; R; COVID-19; Middle Aged; 3. Good health; coronavirus disease; Synopsis; Medicine; Cytokines; Female; Coronavirus Infections; severe acute respiratory syndrome coronavirus 2

There are few detailed investigations of neurologic complications in severe acute respiratory syndrome coronavirus 2 infection. We describe 3 patients with laboratory-confirmed coronavirus disease who had encephalopathy and encephalitis develop. Neuroimaging showed nonenhancing unilateral, bilateral, and midline changes not readily attributable to vascular causes. All 3 patients had increased cerebrospinal fluid (CSF) levels of anti-S1 IgM. One patient who died also had increased levels of anti-envelope protein IgM. CSF analysis also showed markedly increased levels of interleukin (IL)-6, IL-8, and IL-10, but severe acute respiratory syndrome coronavirus 2 was not identified in any CSF sample. These changes provide evidence of CSF periinfectious/postinfectious inflammatory changes during coronavirus disease with neurologic complications.