Neurotropism of SARS-CoV-2: COVID-19 presenting with an acute manic episode. Issue 6 (14th June 2020)

• Record Type: Journal Article
• Authors: Mawhinney, Jamie A; Wilcock, Catherine; Haboubi, Hasan; Roshanzamir, Shahbaz
• Is Part Of: BMJ case reports. Volume 13:Issue 6(2020)
• Publication Date: 2020-06-14
• Subjects: pneumonia (infectious disease) -- infection (neurology) -- psychotic disorders (incl schizophrenia) -- mood disorders (including depression); Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2020-236123
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : A 41-year-old man with no significant medical history presented with acute behavioural disruption on the background of a 1-day history of severe headache and a 10-day history of dry cough and fever. He was sexually disinhibited with pressured speech and grandiose ideas. His behaviour worsened, necessitating heavy sedation and transfer to intensive care for mechanical ventilation despite no respiratory indication. Investigations confirmed that he was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Neuroimaging and a lumbar puncture were normal. Initial screening for SARS-CoV-2 in the cerebrospinal fluid was negative although no validated assay was available. The patient's mental state remained abnormal following stepdown from intensive care. Psychiatric assessment found features consistent with acute mania, and he was detained under the Mental Health Act. This case indicates the need to consider COVID-19 in a wider series of clinical presentations and to develop a validated assay for SARS-CoV-2 in the cerebrospinal fluid.