Case presentation
A 44-year-old female known case chronic bronchitis who was admitted by
respiratory distress one months ago, and received Remdesivir by
diagnosis of COVID-19 infection, after 10 days she discharged with
clinical improvement. Twenty days after disease onset, the patient
gradually developed memory loss and confusion, therefore, she admitted
again. On examination she was confused without any focal neurological
deficits, she did not have fever and meningeal irritation. Her pupils
were isochoric and reactive and plantar reflex were down going. Brain CT
showed severe hydrocephalus (figure 1). Brain MRI did not show any other
pathologies. Lumbar puncture was done and CSF analysis revealed high
protein, low glucose and pleocytosis (Table 1) and treatment with
ceftriaxone (2gr/BD) and vancomycin (1gr/BD) got started and we
continued the treatment. Due to severe hydrocephalus brain extra
ventricular drainage was done for her. The EEG showed generalized slow
activity. CSF evaluated for fungal, tuberculosis, brucellosis,
sarcoidosis, and viral infections including HSV-1,2 and CMV, and
autoimmune antibodies, and they came back positive for anti-GAD65 (Table
1). Malignancy and vasculitis work-up were negative. Due to the negative
CSF culture, antibiotics discontinue and was started 7-day course of
1g/day IV methylprednisolone and she responded very well to medication
and became conscious again and oriented without hallucination and
illusion. Unfortunately, patient had pulmonary thromboembolism(PTE) in
hospitalization and she died.