First case of SARS-COV-2 sequencing in cerebrospinal fluid of a patient with suspected demyelinating disease
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SHORT COMMENTARY
First case of SARS‑COV‑2 sequencing in cerebrospinal fluid of a patient with suspected demyelinating disease Renan Barros Domingues1 · Maria Cássia Mendes‑Correa2 · Fernando Brunale Vilela de Moura Leite1 · Ester Cerdeira Sabino3 · Diego Zanotti Salarini4 · Ingra Claro3 · Daniel Wagner Santos4 · Jaqueline Goes de Jesus3 · Noely Evangelista Ferreira3 · Camila Malta Romano3 · Carlos Augusto Senne Soares1 Received: 19 May 2020 / Revised: 9 June 2020 / Accepted: 11 June 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The association between coronaviruses and central nervous system (CNS) demyelinating lesions has been previously shown. However, no case has been described of an association between the novel coronavirus (SARS-COV-2) and CNS demyelinating disease so far. SARS-COV-2 was previously detected in cerebrospinal fluid (CSF) sample of a patient with encephalitis. However, the virus identity was not confirmed by deep sequencing of SARS-COV-2 detected in the CSF. Here, we report a case of a patient with mild respiratory symptoms and neurological manifestations compatible with clinically isolated syndrome. The viral genome of SARS-COV-2 was detected and sequenced in CSF with 99.74–100% similarity between the patient virus and worldwide sequences. This report suggests a possible association of SARS-COV-2 infection with neurological symptoms of demyelinating disease, even in the absence of relevant upper respiratory tract infection signs. Keywords COVID-19 · SARS-COV-2 · Clinically isolated syndrome · Cerebrospinal fluid
Background
Case report
The novel coronavirus (SARS-COV-2) is associated with respiratory symptoms. There have been reports of COVID19 associated neurological manifestations. The viral genome was demonstrated by RT-PCR technique in cerebrospinal fluid sample (CSF), suggesting that the virus has the ability to infect central nervous system (CNS) [1]. The association between other coronaviruses and CNS demyelinating lesions has been studied [2, 3]. However, no case has been described of an association between SARS-COV-2 and CNS demyelinating disease so far.
A 42 year-old patient, resident in São Paulo, sought neurological consultation due to paresthesias of the left upper limb, later progressing to left hemithorax, and hemiface. Upon neurological examination, she had hypoesthesia in the above-mentioned regions. The patient also had mild respiratory symptoms that included coryza and nasal obstruction without fever for 3 weeks. RT-PCR for SARS-COV-2 of nasal and pharyngeal swab and cerebrospinal fluid (CSF) was carried out. She had a similar neurological clinical picture 3 years ago with spontaneous full recovery of symptoms. As the symptoms were exclusively sensitive and due to the association with SARS-COV-2 infection, the patient was not treated with corticosteroids. The patient had full recovery after 3 weeks. Specific SARS-COV-2 RNA primers and probe directed to RDRP-2 gene described WHO (Charité, Berlim) were used. A control CSF examination was carr
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