The role of the adaptive immune system in mediating COVID-19 is largely unknown. Therefore, it is difficult to predict the clinical course in patients with common variable immunodeficiency (CVID), a disease characterized by dysfunctional lymphocytes and impaired antibody production. We report a case of SARS-CoV-2 infection presenting as isolated neurological symptoms in a patient with CVID. The patient subsequently improved following steroids, intravenous immunoglobulin, and convalescent plasma (CP). The latter has been shown to be safe and efficacious in treating COVID-19 in patients with primary immunodeficiency. Recent data suggest that the mechanism of CNS injury in COVID-19 may be due to immunological dysregulation rather than direct viral-mediated injury. This case exemplifies the complex interaction between the brain, the immune system, and the SARS-CoV-2 virus.
AhmadIRathoreFA. Neurological manifestations and complications of COVID-19: A literature review. J Clin Neurosci. 2020;77:8-12.
2.
BonillaFABarlanIChapelH, et al.International consensus document (ICON): Common variable immunodeficiency disorders. J Allergy Clin Immunol Pract. 2016;4:38-59.
3.
FadakarNGhaemmaghamiSMasoompourSM, et al.A first case of acute cerebellitis associated with coronavirus disease (COVID-19): A case report and literature review. Cerebellum. 2020;19:911-914.
4.
AbramsRMCLehrerHYeungA, et al.A case of elsberg syndrome in the setting of asymptomatic SARS-CoV-2 infection. J Clin Neuromuscul Dis. 2021;22:228-231.
5.
AbramsRMCSafaviFTuhrimSNavisASteinbergerJShinSC. MRI negative myelopathy post mild SARS-CoV-2 infection: vasculopathy or inflammatory myelitis?J Neurovirol. 2021;27:650-655.
6.
Asadi-PooyaAASimaniL. Central nervous system manifestations of COVID-19: A systematic review. J Neurol Sci2020;413:116832.
7.
CohenBRubinsteinRGansMDDengLRubinsteinAEisenbergR. COVID-19 infection in 10 common variable immunodeficiency patients in New York city. J Allergy Clin Immunol Pract. 2021;9:504-507.e1.
8.
TayMZPohCMRéniaLMacAryPANgLFP. The trinity of COVID-19: Immunity, inflammation and intervention. Nat Rev Immunol. 2020;20:363-374.
9.
BaralPKNuruzzamanMUddinMSFerdousMChowdhuryIHSmritySZ. Severe acute respiratory syndrome coronavirus 2 invasion in the central nervous system: A host-virus deadlock. Acta Virol. 2021;65:115-126.
10.
HuangCWangYLiX, et al.Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497-506.
11.
KumarAPrasoonPKumariC, et al.SARS-CoV-2-specific virulence factors in COVID-19. J Med Virol. 2021;93:1343-1350.
12.
VelikovaTVKotsevSVGeorgievDSBatselovaHM. Immunological aspects of COVID-19: What do we know?World J Biol Chem. 2020;11:14-29.
13.
AvouacJDrumezEHachullaE, et al.COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases treated with rituximab: A cohort study. Lancet Rheumatol. 2021;3:e419-e426.
14.
HoHEMathewSPelusoMJCunningham-RundlesC. Clinical outcomes and features of COVID-19 in patients with primary immunodeficiencies in New York City. J Allergy Clin Immunol Pract. 2021;9:490-493.e2.
15.
StokesEKZambranoLDAndersonKN, et al.Coronavirus disease 2019 case surveillance—United States, January 22–May 30, 2020. MMWR. 2020;69:759-765.
16.
CunninghamJLVirhammarJRönnbergB, et al.Anti-SARS-CoV2 antibody responses in serum and cerebrospinal fluid of COVID-19 patients with neurological symptoms. J Infect Dis2021;jiab153.
17.
LeeMHPerlDPNairG, et al.Microvascular injury in the brains of patients with Covid-19. N Engl J Med. 2021;384:481-483.
18.
SolomonIHNormandinEBhattacharyyaS, et al.Neuropathological features of Covid-19. N Engl J Med. 2020;383:989-992.
19.
MatschkeJLütgehetmannMHagelC, et al.Neuropathology of patients with COVID-19 in Germany: A post-mortem case series. Lancet Neurol. 2020;19:919-929.
20.
LudlowMKortekaasJHerdenC, et al.Neurotropic virus infections as the cause of immediate and delayed neuropathology. Acta Neuropathol. 2016;131:159-184.
21.
XiY. Convalescent plasma therapy for COVID-19: a tried-and-true old strategy?Signal Transduct Target Ther. 2020;5:203.
22.
SimonovichVABurgos PratxLDScibonaP, et al.A randomized trial of convalescent plasma in Covid-19 severe pneumonia. N Engl J Med. 2021;384:619-629.
23.
Van DammeKFATavernierSVan RoyN, et al.Case report: Convalescent plasma, a targeted therapy for patients with CVID and severe COVID-19. Front Immunol. 2020;11:596761.
24.
JinHReedJCLiuSTH, et al.Three patients with X-linked agammaglobulinemia hospitalized for COVID-19 improved with convalescent plasma. J Allergy Clin Immunol Pract. 2020;8:3594-3596.e3.
