Cameron G Lanier1, Stacey A Lewis2, Paras D Patel1,3, Ahmed Mohamed Ahmed3, Paul O Lewis1. 1. Department of Pharmacy, 233484Johnson City Medical Center, Johnson City, TN, USA. 2. Department of Nursing, 162625Franklin Woods Community Hospital, Johnson City, TN, USA. 3. Department of Infectious, Inflammatory and Immunologic Diseases, 12324East Tennessee State University Quillen College of Medicine, Johnson City, TN, USA.
Abstract
PURPOSE: To report a case of COVID-19 presenting with acute psychosis, without the hallmark respiratory symptoms of fever, cough, and shortness of breath associated with the novel virus. CASE SUMMARY: A 58 year-old male presented with acute psychosis and no symptoms associated with COVID-19. He denied fever, chills, chest pain, shortness of breath, or gastrointestinal symptoms. The patient had a medical history of coronary artery disease, chronic hepatitis C, polysubstance abuse (including cocaine and alcohol), liver disease, anxiety, and panic disorder. Patient was confused, disruptive, unable to communicate, and admitted to hallucinations. Prior to transfer to a psychiatric facility, the patient developed a cough, triggering COVID-19 testing and a positive result. He was initially treated with hydroxychloroquine before this was discontinued. The patient was treated with haloperidol and lorazepam before returning to baseline. He was discharged home with continued isolation. CONCLUSION: Acute psychosis, with or without other symptoms, appears to be a potential presentation of COVID-19 and should be considered by clinicians as a possible presenting manifestation. Other coronaviruses appear to have also been linked to neurological manifestations, including psychosis. Neurological manifestations of the virus vary widely, but have been reported multiple times. Treatment, as shown in this case report, appears to be supportive and symptom based for the associated psychotic symptoms. Optimal antiviral treatment is still yet to be clearly defined, as research continues on how to best treat the virus itself.
PURPOSE: To report a case of COVID-19 presenting with acute psychosis, without the hallmark respiratory symptoms of fever, cough, and shortness of breath associated with the novel virus. CASE SUMMARY: A 58 year-old male presented with acute psychosis and no symptoms associated with COVID-19. He denied fever, chills, chest pain, shortness of breath, or gastrointestinal symptoms. The patient had a medical history of coronary artery disease, chronic hepatitis C, polysubstance abuse (including cocaine and alcohol), liver disease, anxiety, and panic disorder. Patient was confused, disruptive, unable to communicate, and admitted to hallucinations. Prior to transfer to a psychiatric facility, the patient developed a cough, triggering COVID-19 testing and a positive result. He was initially treated with hydroxychloroquine before this was discontinued. The patient was treated with haloperidol and lorazepam before returning to baseline. He was discharged home with continued isolation. CONCLUSION: Acute psychosis, with or without other symptoms, appears to be a potential presentation of COVID-19 and should be considered by clinicians as a possible presenting manifestation. Other coronaviruses appear to have also been linked to neurological manifestations, including psychosis. Neurological manifestations of the virus vary widely, but have been reported multiple times. Treatment, as shown in this case report, appears to be supportive and symptom based for the associated psychotic symptoms. Optimal antiviral treatment is still yet to be clearly defined, as research continues on how to best treat the virus itself.