Post-infectious rhombencephalitis after coronavirus-19 infection: A case report and literature review

Abstract

A wide number of neurological manifestations have been described in association with coronavirus disease 19 (COVID-19). We describe an unusual case of a young man who developed severe rhombencephalitis after COVID-19. He demonstrated clinical and radiological improvement with high dose corticosteroids, plasma exchange and intravenous immune globulin. Our findings, along with previously reported cases that we review here, support an autoimmune para- or post-infectious mechanism and highlight a possible role for immunotherapy in patients with rhombencephalitis after COVID-19.

Keywords: Brainstem encephalitis; COVID-19; Rhombencephalitis; SARS-CoV-2.

Graphical abstract

Fig. 1

(A) Axial MRI FLAIR sequence demonstrating extensive FLAIR signal abnormality involving the cerebral peduncles, midbrain, pons, and bilateral brachium pontis associated with (B) marked contrast enhancement of the pons, (C) restricted diffusion in the anterior portion of the pons. (D) Coronal views demonstrating the extensive signal abnormality in the braistem.

Fig. 2

(A) Improvement of the signal abnormality in the midbrain, demonstration of FLAIR signal hyperintensity in the bilateral superior cerebellar peduncles and bilateral pons. (B) Demonstrated enhancement in the bilateral pons, similar compared to prior MRI.

Fig. 3

(A) Significantly improved FLAIR signal abnormalities, particularly of the cerebral peduncles and midbrain, pons, and medulla. (B) Enhancement of the bilateral pons significantly improved from prior MRI.