COVID-19 encephalopathy masquerading as substance withdrawal.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), first identified in December 2019 in Wuhan, China, is the virus responsible for the current pandemic known as COVID-19. We report the case of a patient with past medical history of substance abuse who presented with suspected drug overdose. He was agitated and altered in the emergency room and he was treated with benzodiazepines for his agitation. He was admitted for substance withdrawal, however his encephalopathy did not improve and he developed choreiform movements. Metabolic, infectious, and rheumatologic workup was negative until he subsequently tested positive for COVID-19. An MRI was performed which showed multiple focal enhancing lesions primarily affecting the bilateral medial putamen and left cerebellum along with subcortical lesions suggesting COVID-19 encephalopathy. He was given glucocorticoids and his mentation and choreiform movements improved. While neurologic presentations are increasingly becoming more common, encephalopathy with choreiform movements appears to be a rare manifestation of SARS-CoV-2, and may be due to direct viral invasion or, more likely, autoimmune mediated toxicity precipitated by the initial viral infection This article is protected by copyright. All rights reserved.