Generalized myoclonus in two COVID-19 RT-PCR-negative patients with bilateral interstitial pneumonia

ABSTRACT

Introduction: Coronavirus disease 19 (COVID-19) primarily affects the respiratory system. Nevertheless, there are many reports of nervous system involvement and various neurological manifestations affecting the entire neuraxis. The gold standard for diagnosis is considered to be reverse transcriptase polymerase chain reaction (RTPCR) for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). But there is increasing evidence of typical lung involvement and negative RT-PCR results for SARS-CoV-2.
Case reports: We report two patients with a clinical, radiological, and epidemiological history of SARS-CoV-2, both of whom developed generalized myoclonus, while one of them also developed convulsive epileptic status further on. The patients (both male, aged 64 and 69 years) were hospitalized with bilateral polysegmental interstitial pneumonia on X-ray, suggestive of COVID-19 pneumonia. Both had negative results for SARS-CoV-2 RT-PCR. They had generalized myoclonus, with both positive and negative components. Both patients denied a history of regular alcohol consumption and had no major metabolic problems at the time of admission. Conclusion: It is well known that COVID-19 infection can affect virtually the entire neuraxis and manifest with various neurological syndromes. These cases, firstly reported in our hospital, suggest that the occurrence of myoclonus during the COVID-19 pandemic might not be a rarity. Further studies are required concerning the mechanisms and sites of the central nervous system injury causing myocloni and find an optimal treatment regimen. Also, it is still a matter of debate, whether there is a relationship between typical chest computed tomography findings and negative nasopharyngeal swab results.