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Proceedings SNO “Percorsi clinici in Neuroscienze”
Case report I SESSIONE
“LA NEUROLOGIA AL TEMPO DEL COVID-19”
COVID-19-associated autoimmune encephalitis
mimicking acute-onset Creutzfeldt-Jakob disease:
a case report
S. BERETTA* , A. STABILE*, C. BALDUCCI*, J.C. DIFRANCESCO* , A. PATRUNO**,
✧◆
✧◆
R. RONA**, M. BOMBINO**, C. CAPRARO***, F. ANDREETTA , P. CAVALCANTE ,
■
◆
✧
✧
F. MODA ■ ■ , G. CITERIO **, G. FOTI **, G. BOGLIUN*, C. FERRARESE* ✧◆
* Department of Neurology, “S. Gerardo” Hospital ASST Monza, Italy
✧ School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
◆ NeuroMi (Milan Center for Neuroscience), Milano, Italy
** Department of Intensive Care, “S. Gerardo” Hospital ASST Monza, Italy
*** Department of Neuroradiology, “S .Gerardo” Hospital ASST Monza, Italy
■ Department of Neurology 4 - Neuroimmunology and Neuromuscular Diseases,
Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milan, Italy
■ ■ Department of Neurology 5 - Neuropathology, Fondazione IRCCS Istituto Neurologico “Carlo Besta”,
Milan, Italy
CASE REPORT repeated SARS-CoV-2 PCR on both respiratory tract
specimens resulted positive on day 7, when anti-
A 64-year-old man was admitted to the Emergency SARS-CoV-2 antibodies to nucleocapsid antigen
Department with confusion, disorientation, moderate were also found elevated in serum. A diagnosis of
aphasia, mild right hemiparesis and irregular my- late-phase, asymptomatic COVID-19 pneumonia was
oclonic jerks at the right limbs, with a GCS 12 (eyes made.
opening to verbal command, confused, localizing A first EEG showed irregular, left-sided periodic lat-
pain, not obeying commands). His wife reported that eralized epileptiform discharges (Figure 1A), appar-
she saw him normal 3 hours earlier. He neither had ently time-locked with right-sided myoclonus (back
fever nor respiratory symptoms in the previous days. averaging analysis was not performed). Cerebral
His past medical history included hypothyroidism spinal fluid (CSF) analysis showed normal protein
and hypertension. Brain CT and CT-angiography content (18 mg/dL) and cell count (3 cells/uL); com-
were negative. Chest CT scan showed bilateral inter- prehensive virologic testing (including HSV1, HSV2,
stitial pneumonia, while his arterial blood oxygen VZV, EBV, CMV, HHV6, HHV8, adenovirus, en-
was normal. D-dimer levels (387 ng/mL) and C-reac- terovirus, parvovirus B19, JC virus, West Nile virus,
tive protein (7.92 mg/dL) were mildly elevated. influenza A and B virus, respiratory syncytial virus A
Nasopharyngeal swab and bronchoalveolar lavage and B, Zika virus and SARS-CoV-2) was negative, as
tested negative for SARS-CoV-2 on admission, but well as bacterial and fungal cultures. Oligoclonal
Corrispondenza: Dr. Simone Beretta, Dipartimento di Neurologia, Ospedale S. Gerardo, via Pergolesi 33, 20900 Monza (MB), tel.
+39-(0)39-2333568, fax +39-(0)39-2332449, e-mail: simone.beretta@unimib.it
Percorsi clinici in Neuroscienze. Clinical Round SIN e SNO Lombardia, 21 gennaio 2022, Desio (Monza e Brianza)
Atti a cura di Paolo Ferroli, Alessandra Protti, Andrea Salmaggi, Ignazio Michele Santilli, Luca Valvassori
Copyright © 2022 by new Magazine edizioni s.r.l., Trento, Italia. www.newmagazine.it ISBN: 978-88-8041-135-2
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