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Case Reports
. 2021;57(1):158.
doi: 10.1186/s41983-021-00413-1. Epub 2021 Nov 27.

Clinical and morphological features of SARS-COV-2 associated acute hemorrhagic necrotizing encephalopathy: case report

Victor Vladimirovich Ermilov  1 , Nikita Alexeevich Dorofeev  2
Affiliations
Case Reports

Clinical and morphological features of SARS-COV-2 associated acute hemorrhagic necrotizing encephalopathy: case report

Victor Vladimirovich Ermilov et al. Egypt J Neurol Psychiatr Neurosurg. 2021.

Abstract

Background: The current case report presents acute hemorrhagic necrotizing encephalopathy (AHNE) as an example of a fatal complication, the etiology of which could be coronavirus disease 2019 (COVID-19) with multiple organ damage along with the existing respiratory tuberculosis.

Case presentation: A male in his 20s had severe symptoms of central nervous system lesion, which developed against the background of COVID-19 and respiratory tuberculosis, for which he was treated in the intensive care unit. Autopsy confirmed that he died from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) associated AHNE in adults with severe fatal endothelial dysfunction and respiratory tuberculosis. The main morphological signs of brain damage were desquamative endotheliitis, thrombosis, parenchymal hemorrhagic necrosis, encephalitis, severe necrobiotic neuronal damage.

Conclusion: The defeat of endothelial cells with the development of generalized endotheliitis in COVID-19, especially in conjunction with comorbid pathology, in particular tuberculosis, can lead to a fatal complication that affects the nervous system-AHNE. Therefore, it is worth paying close attention to the appearance of neurological symptoms in patients with a similar combination of diseases.

Keywords: Acute hemorrhagic necrotizing encephalopathy; Endothelial dysfunction; Endotheliitis; SARS-CoV-2.

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Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
MRI of the brain. Narrowing of the subarachnoid space. A pathological increase in the intensity of the signal by T2/TIRM and DWI from the cortex of the brain substance is determined, the change in the signal is symmetrical from the basal nuclei with their hemorrhagic transformation. Symmetrically increased T2/TIRM signal from the medial thalamus, periaqueductal gray matter
Fig. 2
Fig. 2
Histological picture of brain lesions. a, b Inflammatory infiltration, spongy and perivascular edema, areas of necrosis, desquamation of the endothelium in the cerebral vessels. ×200. c Fibrinoid necrosis of cerebral vessels. H&E staining. ×100. d AHNE with the formation of a cyst. H&E staining. ×200. e Severe necrobiotic neuronal damage. Nissl staining. ×400
See this image and copyright information in PMC

References

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