Autoimmune encephalitis following recovery of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection

Objective: The novel SARS-CoV-2 predominantly presents with respiratory symptoms. Neurological complications of coronavirus disease 2019 (COVID-19) have been reported including but not limited to encephalopathy, stroke, seizures, meningoencephalitis, GBS, ADEM and myalgias. However, post-infectious COVID-19 autoimmune encephalitis has not been reported. Here, we report a case of post-COVID-19 autoimmune encephalitis. Background: A 60-year-old male physician with a history of recent recovered COVID-19 infection presented with neuropsychiatric complaints including altered mental status, perseveration, disinhibition, word finding difficulty and worsening paranoia. Exam consistent with constructional apraxia, akinetic mutism, bradykinesia, severely impaired delayed recall, and difficulty with complex tasks and multistep commands. Other neurological exam was normal. Cerebrospinal fluid analysis (CSF) demonstrated a glucose of 58, protein of 54, nucleated cell count of 0, RBC 0. SARS-CoV-2 RT-PCR in CSF was inconclusive. Autoimmune encephalitis and paraneoplastic panel in CSF were negative. Positron emission tomography (PET) scan was consistent with abnormal mixed brain hypometabolism and hypermetabolism suggesting an early pattern of autoimmune encephalitis. Detailed neurocognitive testing consistent with severe executive dysfunction. 48 hours of video EEG was suggestive of severe diffuse encephalopathy, no seizures or epileptiform discharges. Patient received treatment with 5 days of intravenous immunoglobulin (IVIg) with marked improvement noted clinically and as well as on repeat PET imaging and neurocognitive testing. Design/Methods: NA Results: NA Conclusions: SARS-CoV-2 infection is associated with respiratory symptoms and complications. There should be high suspicion of autoimmune encephalitis following COVID-19 infection in patients presenting with combination of neurological and neuropsychiatric symptoms following recovery of acute infection. PET scan can be abnormal initially in the autoimmune encephalitis, when EEG, MRI, and CSF studies are in-conclusive. Treatment with IVIg is warranted and clinical improvement can be monitored with pre and post treatment repeat imaging and neuro-cognitive testing. Future studies to understand post COVID autoimmune encephalitis are warranted. Disclosure: Dr. Yousuf has nothing to disclose. Dr. King has nothing to disclose. Dr. Ainger has nothing to disclose. Dr. Hessler has nothing to disclose.