key: cord-0887360-904smk1o
authors: Finsterer, Josef; Matovu, Daniel
title: Exclude differentials before diagnosing SARS-CoV-2 assocaited acute, hemorrhaghic, necrotising encephalitis
date: 2022-02-10
journal: Int J Infect Dis
DOI: 10.1016/j.ijid.2022.02.018
sha: 60af27471e584d62be3560c7ff2a9fff1c131b81
doc_id: 887360
cord_uid: 904smk1o

nan

showing pleocytosis, lactic acidosis, and low glucose, and the cerebral magnetic resonance imaging(MRI) findings acute, hemorrhaghic, necrotising encephalitis(AHNE) was diagnosed [Mierzewska-Schmidt et al. 2021] . Despite maximal treatment, the patient expired shortly after admission to the paediatric intensive-care unit [Mierzewska-Schmidt et al. 2021 ]. The study is appealing but raises concerns, which require discussion.

We do not agree with the notion that SARS-CoV-2 associated AHNE has not been reported in We should be told which tests the "CSF meningoencephalitis PCR panel" included. Particularly we should know if the CSF was investigated for Mycobacterium tuberculosis. Exclusion of tuberculosis is crucial as AHNE has been previously reported in association with cerebral tuberculosis [Ermmilov et al. 2021 ]. Arguments for tuberculous meningitis in the index patient are the mild pleocytosis, low CSF glucose, and lactic acidosis, A limitation of the study is that only a single CSF result was provided. In case of an unproven diagnosis with pleocytosis, it is crucial to track the abnormal CSF parameters over time.

Missing is the confirmation of SARS-CoV-2 in the CSF. To establish a causal relation between COVID-3 that the CSF had been investigated for cytokines, chemokines, and glial markers, as they have been reported to be elevated in immunological central nervous system (CNS) disease following a SARS-CoV-2 infection [Gigli et al. 2020 ].

Missing are the results of the autopsy, particularly the results of neuropathological and microbial investigations of brain tissue and the CSF. Of particular interest is if SARS-CoV-2 could be detected within neurons or glial cells as has been previously reported in patients with encephalitis [Porzionato et al 2021] .

Overall, the interesting study has some limitations which challenge the results and their interpretation.

Cerebral tuberculosis should have been excluded and an autopsy study should have been performed.

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Clinical and morphological features of SARS-COV-2 associated acute hemorrhagic necrotizing encephalopathy: case report

HLA and immunological features of SARS-CoV-2-induced Guillain-Barré syndrome

Acute Necrotizing Encephalopathy Associated With SARS-CoV-2 Exposure in a Pediatric Patient

The case of fatal acute hemorrhagic necrotizing encephalitis in a two-month-old boy with Covid-19

Case Report: The Carotid Body in COVID-19: Histopathological and Virological Analyses of an Autopsy Case Series. Front Immunol