ABSTRACT
Introduction: Pulmonary manifestations are typically presented in SARS-CoV2 infection. Some patients can manifest neurological presentations. Some cases of COVID-19 infection were reported with primary presentation of meningitis, meningitis without pulmonary implication and meningoencephalitis. We believed that in some cases primary and only symptoms are neurological manifestations without pulmonary involvement. Method(s): We report a case of 24-year-old man, immunocompetent, with recurrence of COVID-19 infection, who presents with meningitis without pulmonary involvement. Result(s): Our patient reported first COVID-19 infection in October 2021 with only meningitis symptoms. He wasn't vaccinated. Cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis. Empiric treatment with Acyclovir was started. Pulmonary X-ray was normal. Antigen test for SARS-CoV2 was negative. The result of PCR test for COVID-19 was positive. In 3 weeks, he recovered from COVID-19 infection with meningitis, he was discharged with negative PCR test for SARS-CoV2. After 2 months he presented similar symptoms of meningitis. CSF analysis showed lymphocytic pleocytosis. Similar to the first case, pulmonary X-ray was normal and Antigen test for COVID-19 was positive. CSF DNA for Herpes simplex virus type I, II, IV, Epstein Bar virus, Cytomegalovirus were negative. It's not clear the cause of this type of the disease evolution. Can it be an implication of different circulating viral strains or is it the same COVID-19 variant? Conclusion(s): We present a case of recurrence of COVID-19 infection with primary manifestation of meningitis, without pulmonary involvement. This case presents the possibility of recurrence of COVID-19 infection with the same first symptoms. Copyright © 2022