Brain death in a vaccinated patient with COVID-19 infection

 A 60-year-old woman with medical history notable for type II diabetes, hypertension, atrial fibrillation and systemic lupus erythrematosis presented on May 2, 2021 with a one-week history of fever (Tmax 104 F) and productive cough. Notably, the patient had been vaccinated with an mRNA vaccine (Pfizer, New York, NY) receiving the second dose on February 18, 2021. She underwent routine COVID testing in anticipation of screening colonoscopy procedure and tested positive on April 1, 2021. The patient was negative for SARS-CoV-2 antibodies upon hospital admission on May 3, 2021. The patient was admitted to the ICU due to acute hypoxic respiratory failure on May 9, 2021. She had a complex course which included treatment with broad spectrum antibiotics given her immunocompromised state, high dose steroids for concern for lupus flair, and remdesivir. Hypoxic respiratory failure, complicated by disseminated intravascular coagulopathy (disseminated intravascular coagulopathy) and acute cerebrovascular disease including ischemic, hemorrhagic and venous thrombotic events were contributory to this patient's death. 


Brain death in a vaccinated patient with COVID-19 infection

Jennifer M.Watchmaker   Puneet B.Belani

Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, Box 1234, New York, NY 10029, USA

Highlights

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We detail the clinical course and neuroimaging findings of a critically ill COVID-19 pneumonia patient, who ultimately suffered catastrophic intracranial events and ultimate brain death.

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Diffuse cerebral edema, pseudo-subarachnoid hemorrhage, and no antegrade flow above the terminal internal carotid arteries are imaging features of brain death.

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Our report adds to the limited number of studies reporting on the disease course of COVID-19 infection in immunocompromised patients and is the first to our knowledge that details neuroimaging findings.


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REFERENCE
Watchmaker JM, Belani PB. Brain death in a vaccinated patient with COVID-19 infection. Clinical Imaging. 2022 Jan 1;81:92-5.

Watchmaker JM. Methotrexate/rituximab/tozinameran interaction. Reactions. 1881 Nov;158(13):2021.


PS: a 2024 preprint suggests that some variants of Coronavirus may cause severe brain infection without lung issues and be the primary cause of death.

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