Reversible Encephalopathy Syndrome (PRES) in a COVID-19 patient
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LETTER TO THE EDITORS
Reversible Encephalopathy Syndrome (PRES) in a COVID‑19 patient Lucia Princiotta Cariddi1,5 · Payam Tabaee Damavandi1,6 · Federico Carimati1 · Paola Banfi1 · Alessandro Clemenzi1 · Margherita Marelli2 · Andrea Giorgianni3 · Gabriele Vinacci4,5 · Marco Mauri1,7 · Maurizio Versino1,7 Received: 3 June 2020 / Revised: 13 June 2020 / Accepted: 16 June 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Recently WHO has declared novel coronavirus disease 2019 (COVID-19) outbreak a pandemic. Acute respiratory syndrome seems to be the most common manifestation of COVID-19. Besides pneumonia, it has been demonstrated that SARS-CoV-2 infection affects multiple organs, including brain tissues, causing different neurological manifestations, especially acute cerebrovascular disease (ischemic and hemorrhagic stroke), impaired consciousness and skeletal muscle injury. To our knowledge, among neurological disorders associated with SARS-CoV2 infection, no Posterior Reversible Encephalopathy Syndrome (PRES) has been described yet. Herein, we report a case of a 64-year old woman with COVID19 infection who developed a PRES, and we suggest that it could be explained by the disruption of the blood brain barrier induced by the cerebrovascular endothelial dysfunction caused by SARS-CoV-2. Keywords Reversible encephalopathy syndrome PRES · COVID-19 · Endothelial dysfunction Abbreviations COVID-19 Corona virus disease 19 CTA Computed tomography angiography ED Endothelial dysfunction SARS-Cov2 Severe acute respiratory syndrome covid 2
Lucia Princiotta Cariddi and Payam Tabaee Damavandi contributed equally as first authors. Marco Mauri and Maurizio Versino contributed equally as last authors. * Maurizio Versino maurizio.versino@asst‑settelaghi.it 1
Neurology and Stroke Unit, ASST Sette Laghi, Circolo Hospital, Viale Borri, 57, 20100 Varese, Italy
2
Pneumology Unit, ASST Sette Laghi, Circolo Hospital, Varese, Italy
3
Neuroradiology Unit, ASST Sette Laghi, Circolo Hospital, Varese, Italy
4
Radiology Unit, ASST Sette Laghi, Circolo Hospital, Varese, Italy
5
Clinical and Experimental Medicine and Medical Humanities, Center of Research in Medical Pharmacology, University of Insubria, Varese, Italy
6
University of Milano Bicocca, Monza, Italy
7
University of Insubria, Varese, Italy
Case presentation A 64-year-old woman was admitted to our hospital with a 10-day history of fever and dyspnea treated at home with ceftriaxone. Her medical history included hypertension, gastroesophageal reflux disease, hyperuricemia, dyslipidemia, obstructive sleep apnea and paroxysmal atrial fibrillation. Her medications were: irbesartan/hydrochlorothiazide, acetylsalicylic acid, pantoprazole, rosuvastatin, allopurinol and bisoprolol. She was febrile (39 °C) with marked dyspnea. Neurological examination was unremarkable. Laboratory tests were significant for lymphocytopenia with increased transaminases and LDH. Oxygen saturation was low, thereby oxygen therapy was administered (Table 1). C
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