Several studies have shown the extrapulmonary manifestations of COVID-19 disease caused by the SARS-CoV2 virus. Although extrapulmonary manifestation to the heart, kidney, blood, and skin are common, neurological and cerebrovascular manifestations are rare with most of these cases being described in patients who also have the pulmonary manifestation of the disease. Here we present the case of an 18 year-old male with no prior history of respiratory symptoms who presented to the emergency department with altered mental status. Neurology was consulted and the patient was started empirical on ceftriaxone, vancomycin, dexamethasone, and acyclovir for meningoencephalitis. Urine drug screen, head CT, and brain MRI were negative. EEG revealed mild generalized slowing without epileptiform abnormalities. CSF analysis revealed RBC 2,230 (spun: clear, colorless), WBC 84 (segs 2%, lymphocytes 96%, monocytes 2%), protein 112 mg/dL, glucose 69 mmol/L, and gram stain with no polyps or organisms seen. CSF meningoencephalitis PCR panel for 14 common pathogens was negative. Due to recent contact with co-workers who tested positive, nasopharyngeal SARS-CoV2 PCR was ordered and it returned positive. This patient was diagnosed with acute aseptic meningoencephalitis due to COVID-19 and the vancomycin, ceftriaxone and acyclovir were discontinued. Patient’s encephalopathy improved and he was discharged home on oral steroids
