A 78-year-old man with a history of type 2 diabetes from 10 years ago and CKD from two years ago due to diabetic nephropathy with creatinine in the range of 1.5-2mg/dl .He was treated with insulin glargine. One year ago was diagnosed with dementia and has been hospitalized several times in recent year due to high blood sugar and aspiration pneumonia. His last hospitalization was about 35 days ago in the infectious diseases ward, where he was hospitalized due to fever, sweating, vomiting and lung involvement and suspicious for COVID19 infection. Lab test showed leukocytosis which was associated with severe neutrophilia , lymphopenia and thrombocytopenia , creatinine was 1.5mg/dl (Table 1). The patient was initially treated with hydroxychloroquine and Kaletra (lopinavir/ritonavir) for a possible diagnosis of covid19, on the other hand because of suspected bacterial infection he received Imipenem and levofloxacin. After the RT -PCR for COVID19 from the patient's nasopharynx was negative and according to the radiologist's CT scan report, the patient was more likely had aspiration pneumonia than COVID 19 (Figure 1),so the patient was discharged. Five weeks after discharge, again he was brought to emergency ward wih ambulance due to fever, productive cough, hypoxemia (O2Saturation 80% without oxygen) and loss of consciousness. At emergency room the patient's vital signs were: T: 38.50c, PR: 130 / min , RR: 22 / min, BP: 110/70 mmHg. He was awake on neurological examination, but had no visual or verbal communication and did not obey orders. The pupils are mid-size with response to light and he did not have neurologic focal deficit. He had neck stiffness in all directions. Auscultation the lungs showed crackles in base of both lungs. There were no other significant signs. The patient was transferred to the ICU and further tests such as blood and urine cultures as well as Lumbar Puncture are performed. We repeated the sample of nasopharynx for COVID19 test. The lung CT scan revealed the patchy ground glass opacities in left upper lobe ,accompanied by peri-bronchial thickening and mild pleural effusion on the left side (CORADS- 4).(figure2) In the CSF sample, the protein and sugar were normal, but white blood cells was 60 with predominance of PMN(90%). RT- PCR COVID19 was requested in the CSF sample which was negative. Procalcitonin was more than 10, and ferritin, D-dimer were also high. Creatinine was also increased compared to the previous hospitalization .(Table1)CT scans of paranasal sinuses showed no evidence of sinusitis, CT scan of the brain showed generalized atrophy, and only small vessel disease was reported in Brain-MRI.(figure3) All patient's cultures were negative. CSF sample for herpes virus and tuberculosis was also negative. Therefore, patient was diagnosed with aseptic meningitis due to covid infection and pneumonia, with acute on chronic renal failure which was treated with meropenem, linezolid and fluid therapy. The patient's blood sugar was high at the beginning of admission, which was controlled with basal &short acting insulin. In the course of hospitalization, the patient's fever was stopped after 48 hours and the patient's level of consciousness increased on the fourth day of hospitalization as he made eye and verbal communication. On the 14th day of the patient's hospitalization, suddenly he became tachycard and tachypenic, we suspected to pulmonary thromboembolism so have done pulmonary artery CT angiography and color doppler ultrasound of the veins of both lower limbs which was normal, the CT showed thrombosis in the sub-segmental of right upper lobe branches, in the parenchymal cuttings of the lungs, a consolidation with cavity was evident in the anterior segment of the LUL. Since the thrombosis was sub-segmental so we just continued anticoagulant (heparin) as prophylaxis .After three weeks of treatment with improvement of general condition he was discharged.