Dados do Trabalho

Título

Herphetic encephalitis with flu-like syndrome in a COVID-19 pandemic context: a case report.

RESUMO

Presentation: An 60-years-old previously healthy women, from a countryside city of Amazonas, was referred to our neurologic service with a family-reported history of flu-like symptoms such as fever and coryza, and both retrograde and anterograde amnesia, starting 45 days before her first consult and, a week before, psychomotor agitation and disorientation in time, space, situation and person. Her neurological examination showed GCS scoring 9, with isochoric photoreactive pupils, no signs of meningeal irritation, no alterations in the cranial nerves and no motor deficit. She had bilateral patellar hyperreflexia, left upper limb spasticity, and ipsilateral Babinski and Hoffman signs were present. She was hospitalized and tested positive for COVID-19 and, during the hospitalization, evolved with lowered level of consciousness, seizures and global aphasia. CT showed no signs of hypodensity or bleeding. After discussion, the neurologic team started empirically antibiotic therapy and intravenous Acyclovir and, after 5 days of hospitalization, PCR in cerebrospinal fluid was requested showing HSV-1, and a MRI presenting signal changes with a slight swelling effect and a component of breakdown of the blood-brain barrier, suggestive of a viral inflammatory process. Patient evolved with improvement compared to admission and referred for outpatient follow-up. Discussion: HSV encephalitis representes one of the most devastating forms of encephalitis. Its incidence accounts for up to 20% of all identified viral encephalities. Little is known about the influence of SARS-Cov-2 infection on the CNS and its neurological alterations. Otherwise, some authors state that a proinflammatory status and release of cytokines are the key to manifest other viral encephalitis, specially the ones caused by reactivation of virus from the Herpesviridae family. Kahwagi et al (2022) reported a case of coinfection including encephalitis caused by Varicella-Zoster virus confirmed by lumbar puncture associated with a swab test positive for COVID-19, reinforcing participation of the new coronavirus in dysregulation of immune system and neuroinflammation. Final comments: The case raises greater vigilance in typical neurological conditions of encephalitis that present SARS-CoV-2 co-infection, because, despite the outcome of this correlation isn´t fully established, it is known that the pro-inflammatory state sustained by the coronavirus performs a favorable condition for HSV-1 reactivation.

Palavras Chave

Encephalitis. Neuroinfection. HSV-1. COVID-19. SARS-CoV-2.