COVID‐19 meningitis without pulmonary involvement with positive cerebrospinal fluid PCR

We discuss the case of a 49‐year‐old woman with a past history of hypertension who we diagnosed with COVID‐19 meningitis following two positive CSF RT‐PCR results. In contrast to what was originally believed, the SARS‐CoV‐2 can cause meningitis in isolation, perhaps by crossing the blood‐brain barrier. Hence, it seems essential that physicians maintain a high index of suspicion for neurological involvement among COVID‐19 patients, with early CSF analysis and brain imaging sometimes being indicated. Background Coronavirus disease 2019 (COVID‐19) typically presents with respiratory illness ranging in severity. Neurological complications of the disease remain largely unknown. Herein, we discuss the case of a woman diagnosed with COVID‐19 meningitis following two positive cerebrospinal fluid (CSF) RT‐PCR assays, and highlight the importance of recognizing the neurological manifestations of the disease. Case report The patient was a 49‐year‐old woman with a history of hypertension who presented with non‐specific symptoms (fever, headache, malaise, nausea/vomiting). Chest computed tomography (CT) revealed a lack of pulmonary involvement and oropharyngeal/nasopharyngeal RT‐PCR was negative for COVID‐19. A lumbar puncture was performed on the third day of admission and the CSF analysis elucidated a viral pattern, but the CSF bacterial culture and RT‐PCR assay for herpes simplex virus were both negative. Surprisingly, the CSF RT‐PCR for COVID‐19 was positive. The diagnosis of COVID‐19 meningitis was made and the patient was treated solely with Kaletra®, with a second CSF analysis confirming our unique finding 1 week later. The patient's clinical characteristics improved progressively, and she was discharged in excellent general condition after 21 days. Conclusion In contrast to what was originally believed, the SARS‐CoV‐2 can cause meningitis in isolation, perhaps by crossing the blood‐brain barrier. Hence, it seems essential that physicians maintain a high index of suspicion for neurological involvement among COVID‐19 patients, with early CSF analysis and brain imaging sometimes being indicated.