Publication date: Aug 01, 2025
We report a rare and fatal case of acute hemorrhagic leukoencephalitis (AHLE) as the sole manifestation of COVID-19 in a 76-year-old woman who presented without respiratory symptoms. The patient was admitted with an acute altered mental status following a recent fall and a positive SARS-CoV-2 test. Initial imaging showed a small subdural hematoma; however, further evaluation revealed widespread white matter changes and petechial hemorrhages on MRI, consistent with AHLE. Despite aggressive treatment, including intravenous immunoglobulin (IVIG) and high-dose corticosteroids, the patient showed minimal neurological recovery. Cerebrospinal fluid (CSF) studies revealed elevated protein with no infectious or autoimmune markers, and the brain biopsy was non-contributory. She was ultimately transitioned to hospice care. This case underscores the importance of considering AHLE in COVID-19 patients presenting with isolated neurological deterioration, even in the absence of pulmonary involvement. Prompt recognition and escalation of care are crucial, although the prognosis remains poor.
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| Concepts | Keywords |
|---|---|
| Aggressive | covid-19 |
| Covid | general internal medicine |
| Hematoma | infectious disease medicine |
| Old | intravenous immunoglobulins (ivig) |
| Woman |
Semantics
| Type | Source | Name |
|---|---|---|
| disease | MESH | COVID-19 |
| disease | MESH | Acute Hemorrhagic Leukoencephalitis |
| disease | MESH | subdural hematoma |
| disease | MESH | hemorrhages |
| drug | DRUGBANK | Immune Globulin Human |
| disease | IDO | protein |
| pathway | REACTOME | Reproduction |
| disease | MESH | acute disseminated encephalomyelitis |
| disease | MESH | syndromes |
| disease | MESH | inflammation |
| disease | MESH | demyelination |
| disease | MESH | complications |
| disease | MESH | viral infections |
| disease | MESH | encephalopathy |
| disease | MESH | multiple sclerosis |
| disease | IDO | history |
| disease | MESH | hypertension |
| disease | MESH | hyperlipidemia |
| disease | MESH | transient ischemic attack |
| disease | MESH | emergency |
| disease | IDO | facility |
| disease | MESH | Coma |
| disease | MESH | anisocoria |
| disease | MESH | stroke |
| disease | IDO | blood |
| disease | MESH | respiratory alkalosis |
| drug | DRUGBANK | Sulodexide |
| disease | MESH | vertebral artery stenosis |
| disease | MESH | dissociation |
| drug | DRUGBANK | Potassium |
| drug | DRUGBANK | Creatinine |
| drug | DRUGBANK | Calcium |
| drug | DRUGBANK | Ammonia |
| disease | MESH | infectious disease |
| pathway | REACTOME | Infectious disease |