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COVID-19 encephalitis as a differential diagnosis of a Cyclosporine related Posterior Leukoencephalopathy Syndrome (PRES)
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  • sanda mrabet,
  • Achraf Jaziri,
  • maha araoud,
  • Wissal Sahtout,
  • Dorsaf Zellama,
  • Abdellatif Achour,
  • Nihed Abdessayed,
  • Moncef Mokni,
  • Salma Naija,
  • Sana Ben Amor,
  • Alaa Souissi,
  • Hela Jemni
sanda mrabet
Sahloul University Hospital

Corresponding Author:mrabet1sanda@gmail.com

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Achraf Jaziri
Sahloul University Hospital
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maha araoud
Sahloul University Hospital
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Wissal Sahtout
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Dorsaf Zellama
Sahloul University Hospital
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Abdellatif Achour
Sahloul University Hospital
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Nihed Abdessayed
Farhat Hached University Hospital of Sousse
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Moncef Mokni
Farhat Hached University Hospital of Sousse
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Salma Naija
Sahloul University Hospital
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Sana Ben Amor
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Alaa Souissi
Sahloul University Hospital
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Hela Jemni
Sahloul University Hospital
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Abstract

PRES is a rare neurological disease possibly associated with the use of calcineurin inhibitors like cyclosporine A. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus, is responsible for the outbreak of coronavirus disease 19 (COVID-19) and can cause neurological manifestations. We describe a case of CSA-related PRES whose diagnosis was difficult due to concurrent infection with SARS-CoV-2. The 16-year-old patient was known to have corticosteroid-resistant nephrotic syndrome secondary to minimal change disease. CSA was therefore introduced and on the fifth day of treatment, he presented with seizures followed by fever. Biological and MRI 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 us to rectify the diagnosis and relate the seizures to a CSA-related PRES. We concluded that infection with SARS-CoV-2 could be a differential diagnosis of a PRES related to anticalcineurins.