Journal Home > Volume 7 , Issue 1

To date, only a few cases of intracranial infection related to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) were reported. Here we describe a case of coronavirus disease 2019 (COVID-19) that was comorbid with purulent meningitis. A 62-year-old male patient was diagnosed with moderate COVID-19 and had no fever or cough after treatment. However, he suffered from a head injury and experienced headache and fever immediately after the accident. Computed tomography (CT) of the brain showed bilateral frontal lobe contusion, subdural hematoma, and subarachnoid hemorrhage. In the following days, the patient suffered from recurrent fever, although chest CT did not show evidence of worsening of infection. Several lumbar punctures were made, confirming increased cerebrospinal fluid (CSF) pressure and karyocyte count. SARS-CoV-2 nucleic acid was not detected in CSF but revealed the presence of Escherichia coli. Thus, the patient was diagnosed with purulent meningitis, presumably caused by brain trauma or the immunologic dysfunction caused by COVID-19, which was supported by the significant reduction of all kinds of immune cells. Since immunologic dysfunction is commonly presented in COVID-19 patients, comorbidity with meningitis should be considered when a COVID-19 patient presents with headache and fever. Lumbar punctures and CSF cultures may help in the diagnosis.


menu
Abstract
Full text
Outline
About this article

Comorbidity of purulent meningitis with COVLD-19: A case report

Show Author's information Ping Zhang1Chao Pan1Jiahui Wang1Yang Ma1Huaqiu Zhang2Zhouping Tang1( )
Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China

Abstract

To date, only a few cases of intracranial infection related to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) were reported. Here we describe a case of coronavirus disease 2019 (COVID-19) that was comorbid with purulent meningitis. A 62-year-old male patient was diagnosed with moderate COVID-19 and had no fever or cough after treatment. However, he suffered from a head injury and experienced headache and fever immediately after the accident. Computed tomography (CT) of the brain showed bilateral frontal lobe contusion, subdural hematoma, and subarachnoid hemorrhage. In the following days, the patient suffered from recurrent fever, although chest CT did not show evidence of worsening of infection. Several lumbar punctures were made, confirming increased cerebrospinal fluid (CSF) pressure and karyocyte count. SARS-CoV-2 nucleic acid was not detected in CSF but revealed the presence of Escherichia coli. Thus, the patient was diagnosed with purulent meningitis, presumably caused by brain trauma or the immunologic dysfunction caused by COVID-19, which was supported by the significant reduction of all kinds of immune cells. Since immunologic dysfunction is commonly presented in COVID-19 patients, comorbidity with meningitis should be considered when a COVID-19 patient presents with headache and fever. Lumbar punctures and CSF cultures may help in the diagnosis.

Keywords: COVID-19, SARS-CoV-2, meningitis, brain trauma, intracerebral hemorrhage

References(8)

[1]
Li YC, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol 2020, 92(6): 552-555.
[2]
Yan RH, Zhang YY, Li YN, et al. Structural basis for the recognition of SARS-CoV-2 by full-length human ACE2. Science 2020, 367(6485): 1444-1448.
[3]
Baig A, Khaleeq A, Ali U, et al. Evidence of the COVID-19 virus targeting the CNS: Tissue distribution, host-virus interaction, and proposed neurotropic mechanisms. ACS Chem Neurosci 2020, 11(7): 995-998.
[4]
Zhou LY, Zhang M, Wang J, et al. Sars-Cov-2: Underestimated damage to nervous system. Travel Med Infect Dis 2020, 36: 101642.
[5]
Moriguchi T, Harii N, Goto J, et al. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis 2020, 94: 55-58.
[6]
Duong L, Xu P, Liu A. Meningoencephalitis without respiratory failure in a young female patient with COVID-19 infection in Downtown Los Angeles, early April 2020. Brain Behav Immun 2020, 87: 33.
[7]
Ye MX, Ren Y, Lv T. Encephalitis as a clinical manifestation of COVID-19. Brain Behav Immun 2020, 88: 945-946.
[8]
Qin C, Zhou LQ, Hu ZW, et al. Dysregulation of immune response in patients with Coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis 2020, 71(15): 762-768.
Publication history
Copyright
Rights and permissions

Publication history

Received: 01 December 2020
Revised: 21 January 2021
Accepted: 25 January 2021
Published: 05 March 2021
Issue date: March 2021

Copyright

© The authors 2021

Rights and permissions

This article is published with open access at journals.sagepub.com/home/BSA

Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/ en-us/nam/open-access-at-sage).

Return