COVID-19-Associated Encephalitis Mimicking Glial Tumor

Abstract

Background: Reports on neurologic manifestations of coronavirus disease 2019 (COVID-19) have attracted broad attention. We present an unusual case of COVID-19-associated encephalitis mimicking a glial tumor.

Case description: A 35-year-old woman presented with headache and seizures. T2 fluid-attenuated inverse recovery imaging showed hyperintensities in the left temporal lobe. Magnetic resonance spectroscopy showed an elevated choline peak. Imaging findings were suggestive of high-grade glioma. Antiepileptic medication failed to achieve seizure control. A left anterior temporal lobectomy was performed. The patient had no postoperative deficits, and her symptoms completely improved. Histologic examination revealed encephalitis. Postoperatively, our patient tested positive for COVID-19.

Conclusions: Our case raises awareness of neurologic manifestations of the disease and their potential to mimic glial tumors. For prompt diagnosis and prevention of transmission, clinicians should consider COVID-19 in patients with similar presentation.

Keywords: COVID-19; Coronavirus; Encephalitis; SARS-CoV-2; Spectroscopy.

Figure 1

T1-weighted axial magnetic resonance imaging (MRI) (A) showed an isointense lesion in the left temporal lobe. Lesion appeared hyperintense in T2-weighted axial MRI (B) and fluid-attenuated inversion recovery (C). In long echo time magnetic resonance spectroscopy (D), marked elevation of the choline peak was seen along with a decrease of the N-acetylaspartate peak. Findings were suggestive of high-grade glioma.

Figure 2

Postoperative T2-weighted axial magnetic resonance imaging (A) showed total removal of the left anterior temporal lobe. Histopathologic examination (B) showed concentric lymphocytic infiltration into perivascular spaces causing neuronal damage and diffuse hypoxic changes in surrounding brain parenchyma (hematoxylin-eosin, ×400).