Simultaneous Encephalitis and Neuroretinitis After COVID-19 in a Young Adult: A Case Report

Abstract

Coronavirus disease 2019 (COVID-19) pandemic greatly impacted many aspects of life in the world. Both neurological and ophthalmologic presentations after COVID-19 have been reported. Herein, we present a case of both neuroretinitis and encephalitis after COVID-19 in a young adult. Both presentations are among the rare presentations of COVID-19. Similar manifestations were not reported previously. The 18-year-old previously healthy girl initially presented with low-grade fever, nausea, vomiting, body pain, and headache. The patient tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcriptase-polymerase chain reaction (PCR) by using a nasal swab. Two days after the onset of COVID-19 symptoms, she reported blurred vision in both eyes, progressing to only light perception in 3 days. Based on the ophthalmological evaluation, she was diagnosed with neuroretinitis. A few days later, she gradually became drowsy, so she was referred for neurological evaluation. Brain magnetic resonance imaging (MRI) showed bilateral medial temporal T2 and fluid-attenuated inversion recovery (FLAIR) hyper-signal lesions suggestive of encephalitis. A low-dose steroid was started to treat the neuroretinitis. After about 2 weeks, significant improvement in visual acuity and resolution of retinitis patches were observed. Our case is rare in respect of both neurological and ophthalmic involvement.