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Título

One more case report of a patient with COVID-19 and encephalopathy associated with possible Lance-Adams syndrome without cardiac arrest

RESUMO

Case Presentation: A diabetic, hypertensive, with heart and chronic renal disease and ex-smoker 78-year-old man was admitted to the emergency department with acute dyspnea, sweating and fever. A chest CT scan revealed hypo-expanded lungs, atelectasis signs in the bilateral lower lung lobes, right pleural effusion and cardiomegaly. A new chest CT showed diffuse and bilateral ground-glass opacities and a nasopharyngeal swab RT-PCR for SARS-CoV-2 was positive. The patient evolved with lowering of consciousness level associated with left upper limb rapid and repetitive movements described as myoclonus. The electroencephalogram (EEG) showed a diffuse slowing, in the theta/delta range, and periods of generalized attenuation confirming an encephalopathy pattern. There is no previous cardiac arrest. The patient died a few weeks later, after clinical worsening and complications of his renal condition. Discussion: We report a rare case of COVID-19 infected patient with severe hypoxia evolving with decrease of consciousness level and focal myoclonus. There are several studies in the literature showing the occurrence of de novo epileptic seizures in SARS-CoV-2 infection, which was not confirmed in this case (DELORME et al., 2020; DIXON et al., 2020; SOMANI et al., 2020). On the other hand, Lance-Adams syndrome is associated with severe hypoxemic states of different etiologies and seems to be reported in very few COVID-19 patients (MUDDASSIR et al., 2021). Final Comments: The present case is representative about the severe outcome associated to nervous system involvement and includes the COVID-19 hypoxemic state among the differential diagnosis of Lance-Adams syndrome without previous cardiac arrest. Biological mechanism associated with the severe outcome is still a challenge to be understood and this report may contribute adding up to a few cases describing so far.