Title: Meningitis as an initial presentation of COVID-19: A case report


Novel coronavirus (SARS-CoV-2) emerged in Wuhan, China, and it most commonly presents with respiratory symptoms ranging from cough, low-grade fever to severe pneumonia. Neurological complications of COVID-19 remain largely unfamiliar and sometimes the unique initial presenting complaint of COVID-19. We reported the first unique presentation of SARS—CoV-2 virus in a 21-years-old medical student, who presented with initial signs and symptoms of meningitis and later on developed respiratory symptoms on the second day of admission. An extensive work-up was done to evaluate the cause of meningitis, the results of which were unremarkable (Table 1). As per hospital protocol and based on respiratory symptoms, a nasopharyngeal swab for SARS-CoV-2 was sent, the result of which came out positive. He was labeled as a case of meningitis secondary to probably SARS-CoV-2 infection, as no other causative factor was found. His condition deteriorated and unfortunately, he died because of multi-organ failure. Conclusion: The SARS-CoV-2 virus can cause neurological manifestations by various proposed mechanisms. It can spread to the braindirectly through angiotensin-converting enzyme receptors 2 or it can affect the brain through hematogenous spread or neuronal pathway. As these neurological manifestations are fatal, a physician should keep in mind all these manifestations, while encountering patients, especially during this pandemic. Early diagnosis can have a good outcome for the patients as well as we can prevent the vertical spread of this virus by taking precautionary measures.


Muhammad Hanif is an international medical graduate from Pakistan. He is currently working as an internal medicine resident at Hayatabad Medical complex, Peshawar, Pakistan. He is ECFMG certified.