case report of 78-year-old man with meningitis, pulmonary thromboembolism and sars-coronavirus-2 infection

The novel coronavirus infection involves both the central and peripheral nervous systems. some of the presentations include acute cerebrovascular disease, impaired consciousness, transverse myelitis, encephalopathy, encephalitis, and epilepsy. our patient was a 78-year-old man with dementia and diabetic nephropathy who was admitted two times for possibly covid-19 infection. at the first hospitalization, the patient is treated with hydroxychloroquine and kaletra based on clinical symptoms and initial laboratory findings due to suspicion of covid-19. after the negative rt-pcr test of the nasopharyngeal sample for covid-19 and evidence of aspiration pneumonia in ct scan, the patient was discharged with oral antibiotics. five weeks later, he was rehospitalized with loss of consciousness, fever, and hypoxemia in the physical exam; he had neck stiffness in all directions, so the central nervous system (cns) infection was suspected, the cerebrospinal fluid (csf) sample was in favor of aseptic meningitis and second rt-pcr test of nasopharyngeal sample for covid-19 was positive, but brain mri just showed small vessel disease without evidence of encephalitis. in the second hospitalization, he had acute renal failure, which was treated with supportive care, and also suffered from pulmonary embolism with cavitary lesions in his lungs. meningitis with pulmonary embolism and acute renal failure have not yet been reported. our patient is the first one, so we decided to share it. this case showed a different presentation of covid-19 without typical lung involvement. so, we must pay attention to any signs and symptoms in a patient suspected of having a covid-19.