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 CASE REPORT
Year : 2021  |  Volume : 69  |  Issue : 5  |  Page : 1424--1426

Catastrophic Presentation of COVID-19 with Solitary Large Denovo Tumefactive Demyelination


1 Department of Neurology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
2 Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
3 Department of Transfusion Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
4 Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
5 Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
6 Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Correspondence Address:
Samhita Panda
Additional Professor and Head, Department of Neurology, All India Institute of Medical Sciences, Jodhpur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.329572

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Background: The ongoing Coronavirus disease-19 (COVID-19) pandemic has revealed a plethora of extrapulmonary manifestations including neurological presentations. To date, nervous system demyelination has been relatively infrequently reported in this setting. Also, while most data point toward immune activation as a causative process, few studies propound a direct effect. Case Description: A 35-year-old man presented with severe new-onset headache, hemiparesis, and focal seizures culminating in deeply altered sensorium. Radiological evaluation showed a large expansile demyelinating lesion in the right cerebral hemisphere. Nasopharyngeal swab COVID reverse transcription–polymerase chain reaction (RT-PCR) was positive. After initial non-response to steroids, the patient responded well to plasma exchange leading to complete recovery. Conclusions: This report highlights a case of active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection presenting with tumefactive demyelination and subsequent response to therapy. It is important to recognize atypical presentations at this juncture as it may be crucial for planning treatment strategies.






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