A 43-year-old man was taken to the ER department by his mother. She reported her son`s symptoms had started 3 days after his father was diagnosed with Covid-19. The patient presented with tachylalia, disorganized ideas, restlessness, delusions of grandeur, emotional lability, hetero aggression and aggression towards his mother. His mother revealed a past history only relevant for hetero-aggression episodes which usually resolved during 48 hours but they had never asked for medical help as the patient was socially functional and had a stable job.
Aside from his psychiatric symptoms his vitals were normal, and his physical exam did not reveal any other significant sign.
Because of his father´s previous diagnosis of Covid-19, a PCR SARS-CoV-2 was obtained. Neurology and Psychiatry were consulted.
While results were pending, we documented hypokalemia K 3.3, elevation of hepatic enzymes (TGO 53, TGP 69), indirect hyperbilirubinemia (Total bilirubin 2.07, Indirect bilirubin 1.73, Direct bilirubin 0.34), and elevated ferritin levels (Fe 595). The rest within normal limits PCR: 1.8, VSG: 10, Procalcitonin: 0.05, Fibrinogen: 297.
An MRI of the brain was obtained in order to look for strokes or encephalitis related to Covid-19. However, there were no significant findings
CT was performed looking for glass ground opacities suggestive of COVID 19
Because of the non-significant findings, we decided to perform a spinal tap and the cytological test reported: transparent, with 0 leucocytes, 0 erythrocytes, 0 crenocytes. Glucose 65.6, Proteins 17.5, the Gramm stain did not report any organisms, bacterial antigens were negative, viral PCR did not detect any pathogen. Chinese ink was negative.
The PCR for SARS-CoV-2 came back positive and the diagnosis of a psychotic manic episode and Covid-19 was made. Because of the isolation conditions of the hospital, family members decided to take the patient home in a voluntary discharge. However, he will receive follow-up by the neurologist and infectious diseases specialist. The patient consented to the publishing of his experience.