21 September 2023: Articles
Prion Disease After COVID-19: A Case Report
Unknown etiology, Challenging differential diagnosis, Rare disease
Karim Makhoul A , Tova Beeber A , Ryan Cordero A , Areej Khan A , Merjona Saliaj A*DOI: 10.12659/AJCR.940564
Am J Case Rep 2023; 24:e940564
Table 2. Post-COVID PrD case reports in the literature.
| Case | Age | COVID related manifestations | Clinical manifestations related to CJD | Time to onset of CJD | Tests supportive of CJD diagnosis | Progression | Death |
|---|---|---|---|---|---|---|---|
| Young 2020 []6 | 60 | Fever, PCR positive | Confusion, dementia, slowness, paucity of speech with paraphasic errors, unsteady gait with intermittent right-hand clenching, perseveration, anomia, impaired comprehension, and intermittent myoclonic jerks of the right arm | Confusion at onset with worsening over the next 2 weeks | CSF RT-QuIC, 14-3-3 and T-tauBrain MRI diffusion restriction in the left hemisphere and left caudate and thalamusEEG 1 Hz periodic lateralized discharges | Mutism, right hemiplegia, somnolence agitation | 2 months later |
| Beretta 2021 []4 | 64 | No fever or respiratory symptoms | Confusion, disorientation, moderate aphasia, mild right hemiparesis, and irregular myoclonic jerks at the right limbs, with a Glasgow Coma Scale (GCS) 12 (eyes opening to verbal command, confused, localizing pain, not obeying commands) | Symptoms at onset | 14-3-3 positiveRT-QuIC negativeEEG with left sided lateralized periodic dischargesMRI cortical ribbon of the left perisylvian regions | Total recovery | NA |
| Bernardini 2022 []5 | 40 | March 2021 persistent fatigue and transient hyposmia and hypogeusiaSARS-CoV-2 serology showed positive anti-Receptor Binding Domain (RBD) Spike 1 total antibodies at high titer | Black shadows when closing his eyes, followed by dizziness, difficulty reading and worsening of balance. In June 2021 he noticed loss of coordination of the left arm | 2 months | EEG recordings showed diffuse theta slowing with generalized triphasic 1–2 Hz periodic sharp-wave complexesvery high NfL levels. high total Tau levels, slightly reduced beta-amyloid 1–42 and normal phospho-Tau-181 and beta-amyloid 42/40 ratio. Real-Time Quaking-Induced Conversion (RT-QuIC) CSF testing for PrP was positive | bedridden | Was alive at the time of publication |
| Olivo 2022 []7 | COVID swab positive | inability to sign, compromised coordination and paresis to the right leg speech impairments, dystonia and myoclonus. mild right hemiparesis, non-fluent speech and bilateral myoclonus augmented by startle | Neurologic manifestation at onset | MRI scan and highlighted the presence of a diffuse cortical ribboning in DWI periodic triphasic complexes were observed at EEG RT-QuIC results confirmed the probable diagnosis of CJD | Akinetic mutism | Death |