ABSTRACT
Neurologic complications are being recognized as important outcomes of coronavirus disease 2019 (COVID-19). Pathogenesis is varied and incompletely understood, and may include neuroinvasion, indirect post-infectious neuroinflammation, and cerebrovascular pathologies. We present a case of COVID-19-related encephalomyeloradiculitis with clinical and magnetic resonance imaging characteristics of neuromyelitis optica spectrum disorders that was associated with anti-aquaporin-4 antibodies. Our case suggests post-infectious autoimmunity as a mechanism in at least a subset of patients with COVID-19-related neurologic disease.
Subject(s)
Aquaporin 4/immunology , Autoantibodies/analysis , Autoimmune Diseases/etiology , COVID-19/complications , Encephalomyelitis/etiology , Radiculopathy/etiology , Azathioprine/therapeutic use , Brain/diagnostic imaging , COVID-19/diagnostic imaging , Encephalomyelitis/diagnostic imaging , Encephalomyelitis/immunology , Female , Humans , Immunosuppressive Agents/therapeutic use , Magnetic Resonance Imaging , Middle Aged , Neuromyelitis Optica/diagnostic imaging , Neuromyelitis Optica/etiology , Plasma Exchange , Radiculopathy/diagnostic imaging , Radiculopathy/immunology , Spine/diagnostic imagingSubject(s)
Coronavirus Infections , Critical Care/methods , Magnetic Resonance Imaging/methods , Multiple Organ Failure , Myelitis, Transverse , Neuromyelitis Optica , Pandemics , Paresis , Pneumonia, Viral , Spinal Cord/diagnostic imaging , Aged , Antibodies/blood , Aquaporin 4/immunology , Betacoronavirus/isolation & purification , COVID-19 , Clinical Deterioration , Coronavirus Infections/complications , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Diagnosis, Differential , Fatal Outcome , Humans , Male , Multiple Organ Failure/diagnosis , Multiple Organ Failure/etiology , Myelitis, Transverse/diagnosis , Myelitis, Transverse/etiology , Myelitis, Transverse/physiopathology , Neurologic Examination/methods , Neuromyelitis Optica/diagnosis , Neuromyelitis Optica/etiology , Neuromyelitis Optica/physiopathology , Neuromyelitis Optica/therapy , Paresis/diagnosis , Paresis/etiology , Paresis/physiopathology , Pneumonia, Viral/complications , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , SARS-CoV-2 , Sepsis/etiology , Sepsis/therapyABSTRACT
Coronavirus disease 2019 (COVID-19) is caused by the novel coronavirus SARS-CoV-2, which affects the lung and other organs. After an incubation period of 3-14 days, the infection presents with symptoms of variable severity, from mild flu-like disease to severe pneumonia and cytokine storm with increased mortality. Immunosuppressed patients may have higher risk of adverse outcomes; hence, there is an urgent need to evaluate the immune response and clinical outcomes of SARS-CoV-2 infection in these patients. Here, we report a 59-year-old woman with aquaporin-4-positive (AQPR4+) neuromyelitis Optica treated with rituximab who developed mild respiratory symptoms with COVID-19, despite B cell depletion at the time of infection.