Tumefactive Acute Disseminated Encephalomyelitis after Recent Covid-19 Infection: A Case Report

Objective: To report a case of a patient with recent mild to moderate COVID-19 infection who developed tumefactive acute disseminated encephalomyelitis. Methods: Patient data were obtained from medical records from the University of Wisconsin – Madison Hospitals in Madison, WI, USA. Results: We report a 59-year-old man with past medical history notable for atrial fibrillation, biventricular pacemaker, end-stage renal disease secondary to idiopathic fibrillary glomerulonephritis, on hemodialysis awaiting transplantation, who presented with ongoing cognitive changes and pneumonia. He was repeatedly COVID-19 positive with minimal symptoms for 4 weeks prior to admission. He developed right sided hemiparesis and persistent, progressive encephalopathy manifesting primarily with disorientation, agitation, and aggression. CSF was notable for cell count of 7, protein of 48, and glucose of 65. Anti-MOG antibody and AQP-4 antibody were negative. A series of CT/CTA head imaging with and without contrast showed progressive multifocal supratentorial areas of white matter hypoattenuation and MRI head with and without contrast demonstrated progressive multi-focal large ovoid T2 FLAIR hyperintensities, partially ring enhancing on contrasted portion of study, consistent with tumefactive demyelinating disease. Significant improvement in mental status and right sided hemiparesis symptoms was observed with initiation of corticosteroids. Conclusion: This case study provides neuroimaging evidence and clinical correlation to support that SARS–CoV-2 and resultant COVID-19 infection can lead to tumefactive acute disseminated encephalomyelitis. This complication has not been previously documented associated with recent COVID-19 infection.