Coronavirus disease-19 encephalitis as a differential diagnosis of a cyclosporine related posterior leukoencephalopathy syndrome: A case report

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Published Jun 28, 2024
https://doi.org/10.62438/tunismed.v102i7.5027
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Vol. 102 No. 7 (2024): Tunis Med jul 2024

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Sanda Mrabet
Department of Nephrology, Dialysis, and transplantation. Sahloul University Hospital. Sousse. Tunisia
Achraf Jaziri
Department of Nephrology, Dialysis, and transplantation. Sahloul University Hospital. Sousse. Tunisia
Maha Araoud
Department of Nephrology, Dialysis, and transplantation. Sahloul University Hospital. Sousse. Tunisia
Dorsaf Zellama
Department of Nephrology, Dialysis, and transplantation. Sahloul University Hospital. Sousse. Tunisia
Salma Naija
Department of Neurology. Sahloul University Hospital. Sousse. Tunisia.
Sana Ben Amor
Department of Neurology. Sahloul University Hospital. Sousse. Tunisia.
Alaa Souissi
Department of Radiology. Sahloul University Hospital. Sousse. Tunisia
Héla Jemni
Department of Radiology. Sahloul University Hospital. Sousse. Tunisia

Abstract

Introduction: Posterior leukoencephalopathy syndrome (PRES) is a rare neurological disease possibly associated with the use of calcineurin inhibitors like cyclosporine A (CSA). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) responsible for the outbreak of coronavirus disease 19 (COVID-19) can cause neurological manifestations. We described a case of CSA-related PRES whose diagnosis was difficult due to a concurrent infection with SARS-CoV-2.


Observation: The 16-year-old patient was known to have corticosteroid-resistant nephrotic syndrome secondary to minimal change disease. CSA was introduced, and on the fifth day of treatment, the patient presented with seizures followed by fever. Biological and magnetic resonance imaging data were in favor of SARS-CoV-2 encephalitis. Relief of immunosuppression by discontinuation of CSA was decided and the patient was put on anticonvulsants. After being declared cured of COVID-19, which was without other clinical signs, the CSA was reintroduced but the patient presented with seizures the next day. This allowed the physicians to rectify the diagnosis and relate the seizures to a CSA-related PRES.


Conclusion: Infection with SARS-CoV-2 could be a differential diagnosis of a PRES related to calcineurin inhibitors.

Keywords:

calcineurin inhibitors , encephalopathy , glomerulonephritis, virus infection

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