A man’s encounter with covid-19 likely led to him experiencing life-threatening catatonia that erased days of his memory, according to doctors in Sweden. Though the man was able to recover without serious brain damage thanks to prompt treatment, the doctors warn that the man’s case may highlight a never-before-seen form of neurological complication connected to an autoimmune condition caused by the coronavirus.
The 40-year-old man’s grueling case was detailed in a report released this week on the preprint website medrxiv.
According to the report, the previously healthy man arrived at the hospital agitated, grimacing, and with fever, exhibiting repetitive speech and movements. Because of his bizarre, disorganized, and uncooperative behavior, he was involuntarily admitted for care. A few hours into admission, he became mute, while his body temperature spiked to over 102 degrees Fahrenheit. He also began having involuntary muscle contractions that left his body and arms rigid, as well as heart and circulation problems. Soon, doctors decided to constantly sedate and intubate him.
Though the doctors weren’t sure exactly what was going on, they suspected that the man’s immune system was overreacting and affecting his brain negatively, likely because of his recent infection from the coronavirus that causes covid-19. Twenty-two days before his hospitalization, he began experiencing the classic respiratory symptoms associated with covid-19, though apparently his illness wasn’t serious, and a week after that, he tested positive for the virus.
On the basis of that diagnosis, they decided to treat him with steroids and the filtering out of his blood plasma, which contains immune cells and antibodies—a treatment plan intended to calm down his immune system. Six days into hospitalization, the man began to show dramatic improvement and was able to stay aware and communicative. But he had completely lost any memory of the past few days. Over the next several weeks, he slowly recovered, though he still experienced visual hallucinations and other cognitive problems during that time.
“I would like to stress that this is not peer-reviewed and preliminary data. We are looking forward to input from the community,” study author Janet Cunningham, an associate professor of experimental psychiatry at Uppsala University in Sweden, said over email. “The patient is gradually recovering but still has some problems with memory and fatigue.”
The symptoms that landed him in the hospital, Cunningham and her team concluded, were the manifestation of malignant or lethal catatonia, a rare form of the condition that’s associated with being immobile and unresponsive to external stimuli. This form of catatonia can be life-threatening, because it can lead to the shutdown of the body’s automatic functions, like breathing and pumping blood.
Without the early treatment the man received, they added, it’s possible he might have died or suffered severe neurological damage. Fortunately, later tests showed that he didn’t have any signs of structural brain damage.
This case isn’t the first to connect the novel coronavirus, SARS-CoV-2, to neurological problems indirectly caused by infection, nor is it the first to show this happening in people who only had mild-to-moderate initial symptoms. Many infections can trigger this type of overreaction by the immune system against the brain, which is called autoimmune encephalitis and is fortunately rare.
There are other neurological conditions that cause the sort of strange symptoms the man displayed. But according to the doctors, there’s never been a case where autoimmune encephalitis was thought to be the source of them. That raises the possibility, they wrote, “that this may be a novel form of autoimmune encephalitis induced by infection with SARS-CoV-2.”
The frightening case is yet another reminder that we’ve just scratched the surface of understanding covid-19's range of effects in people. It may also be hard to spot some of these more exotic complications in time, Cunningham noted, since the initial battery of tests they ran on the man, which included blood tests and a brain CT scan, failed to find anything abnormal that could have explained his symptoms.
“I think the most important implication is that despite the severity of the symptoms, many of the standard investigations were normal or nearly normal and we could easily have missed the diagnosis,” she said.
This article has been updated with comments and clarification from one of the study’s authors.