In this brief report, Poyiadji et al. describe the first presumptive case of COVID-19–associated acute necrotizing encephalopathy (ANE) in a 50-year-old female patient who presented with a 3-day history of cough, fever, and altered mental status. Brain MRI demonstrated haemorrhagic rim enhancing lesions within the bilateral thalami, medial temporal lobes, and subinsular regions and the patient was treated with intravenous immunoglobulin. Acute necrotizing encephalopathy is a rare complication of influenza and other viral infections and has been related to intracranial cytokine storms, which result in blood-brain-barrier breakdown, but without direct viral invasion or parainfectious demyelination. Interestingly, cytokine storm syndrome has been recently reported in COVID-19 patients and might play a key role in the development of ANE.
by Marialuisa Zedde and Francesco Cavallier