Posterior Reversible Encephalopathy Syndrome in a Patient With SARS-CoV-2 Infection Treated With Tocilizumab

Krishna Talluri; Naveena Lall; Marcos A Moreno; Laura Nichols; Dinesh Bande

doi:10.7759/cureus.13475

Posterior Reversible Encephalopathy Syndrome in a Patient With SARS-CoV-2 Infection Treated With Tocilizumab

Cureus. 2021 Feb 21;13(2):e13475. doi: 10.7759/cureus.13475.

Authors

Krishna Talluri^{1

2}, Naveena Lall², Marcos A Moreno², Laura Nichols^{1

2}, Dinesh Bande^{3

1}

Affiliations

¹ Internal Medicine, Sanford Health, Fargo, USA.
² Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, USA.
³ Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo, USA.

Abstract

As the world has struggled to adapt to the coronavirus disease (COVID-19) pandemic, new evidence has emerged suggesting that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may manifest with a wide variety of neurologic symptoms. We present the case of a 70-year-old patient hospitalized for COVID-19 related pneumonia who was treated with off-label interleukin (IL)-6 inhibitor tocilizumab and eventually developed prolonged delirium. MRI findings were consistent with posterior reversible encephalopathy syndrome (PRES). PRES was felt to be from SARS-CoV-2 infection, tocilizumab, or a combination. The patient received symptomatic treatment without success. These findings are consistent with few other recent reports, which have chronicled PRES findings in patients with SARS-CoV-2 infections. However, this is only the second example of PRES in a COVID-19 patient treated with tocilizumab. While cases of PRES have been noted to occur with other infectious diseases, clinicians should be aware of the association with SARS-CoV-2 infection and tocilizumab therapy, particularly when considering tocilizumab treatment outside its approved indication. Future research efforts are needed to establish evidence-based guidelines for the management of these patients.

Keywords: case report; covid-19; pres; sars-cov-2; tocilizumab.

Publication types

Case Reports