Background: This study represents an additional case of a rare entity and complication of COVID-19. Purpose: To further describe COVID’s association with acute hemorrhagic leukoencephalopathy (AHL), a variant of acute disseminated encephalomyelitis. Besides, subsequent neuropsychological evaluation is described. Methods: The present case report describes clinical, laboratory, radiological, and electroencephalographic characteristics of AHL triggered by COVID-19, in addition to outcomes in the neuropsychological findings. Results: Radiologic findings of demyelinating lesions in supratentorial white matter permeated by multiple hemorrhagic foci supported the diagnostic of AHL, reinforced by clinical improvement after corticosteroid therapy. Conclusions: There are few similar cases previously reported, and this case highlights the early diagnosis and prompt treatment looking forward to better outcomes in AHL. Further studies are needed to elucidate the involved pathophysiological mechanisms.
WiersingaWJRhodesA.ChengA. C.PeacockSJPrescottHC. Pathophysiology, transmission, diagnosis, and treatment of Coronavirus disease 2019 (COVID-19). JAMA. 2020;324:782–793. doi:10.1001/jama.2020.12839.
2.
WangYWangYHuoLLiQChenJWangH. SARS-CoV-2-associated acute disseminated encephalomyelitis: A systematic review of the literature. J Neurol2021;1–22. doi:10.1007/s00415-021-10771-8. https://doi.org/10.1007/s00415-021-10771-8.
3.
ManzanoGSMcEntireCRSMartinez-LageMMateenFJHuttoSK. Acute disseminated encephalomyelitis and acute hemorrhagic leukoencephalitis following COVID-19: Systematic review and meta-synthesis. Neurol Neuroimmunol Neuroinflamm. 2021;8(6):e1080. doi:10.1212/NXI.0000000000001080.
4.
PohlDAlperGVan HarenK, et al.Acute disseminated encephalomyelitis. Neurology. 2016;87:S38-S45. doi:10.1212/WNL.0000000000002825.
5.
WaakMMaloneSSinclairK, et al.Acute hemorrhagic leukoencephalopathy: Pathological features and cerebrospinal fluid cytokine profiles. Pediatr Neurol. 2019;100:92–96. doi:10.1016/j.pediatrneurol.2019.06.013.
6.
YongMHChanYFZLiuJ, et al.A rare case of acute hemorrhagic leukoencephalitis in a COVID-19 patient. J Neurological Sciences. 2020;416:117035. doi:10.1016/j.jns.2020.117035.
7.
ChalilABakerCSJohnstonRB, et al.Acute hemorrhagic encephalitis related to COVID-19. Neurol Clin Pract. 2021;11:e147–e151. doi:10.1212/CPJ.0000000000000900.
8.
HandaRNandaSPrasadA, et al.Covid-19-associated acute haemorrhagic leukoencephalomyelitis. Neurol Sci. 2020;41(11):3023–3026. doi:10.1007/s10072-020-04703-z.
9.
KarapanayiotidesTGekaEPrassopoulosP, et al.Concentric demyelination pattern in COVID-19-associated acute haemorrhagic leukoencephalitis: A lurking catastrophe?Brain. 2020;143(12):e100. doi:10.1093/brain/awaa375.
10.
GhoshRDubeySFinstererJ. SARS-CoV-2-associated acute hemorrhagic, necrotizing encephalitis (ahne) presenting with cognitive impairment in a 44-year-old woman without comorbidities: A case report. Am Journal Case Reports. 2020;21:e925641. doi:10.12659/AJCR.925641.
11.
PerrinPCollonguesNBalogluS, et al.Cytokine release syndrome‐associated encephalopathy in patients with COVID‐19. Eur J Neurol. 2021;28(1):248–258. doi:10.1111/ene.14491.
12.
WalkerJMGilbertARBieniekKFRichardsonTE. COVID-19 patients with CNS complications and neuropathologic features of acute disseminated encephalomyelitis and acute hemorrhagic leukoencephalopathy. J Neuropathol Exp Neurol. 2021;80(6):628-631. doi:10.1093/jnen/nlab036.
13.
VaradanBShankarARajakumarA, et al.Acute hemorrhagic leukoencephalitis in a COVID-19 patient-a case report with literature review. Neuroradiology. 2021;63(5):653–661. doi:10.1007/s00234-021-02667-1.
14.
HaqiqiASamuelsTLLambFJ, et al. Acute haemorrhagic leukoencephalitis (Hurst Disease) in severe COVID-19 infection. Brain Behav Immun Health2021;12:100208. doi:10.1016/j.bbih.2021.100208. https://doi.org/10.1016/j.bbih.2021.100208.
