PMC:7253233 / 6377-8341 JSONTXT

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MRI of the brain and cervical spine with and without contrast was remarkable only for chronic white matter hyperintensities, without acute intracranial lesions, meningeal enhancement or venous sinus thrombosis, and C5–C6 myelomalacia, respectively. Lumbar puncture was not performed due to the risk of seeding infection into neuroaxis. Given persistent high-grade fevers, worsening respiratory status requiring intubation, and recent possible exposures, a respiratory viral panel was sent in addition to separate rapid testing for COVID-19 polymerase chain reaction on postoperative day 4 and COVID-19 testing was confirmed as positive twenty-four hours later. His fibrinogen level was elevated at 631 mg/dL (normal range 200–400 mg/dL) and continued to increase to over 860 mg/dL over the following days. C-reactive protein increased from 1.7 mg/dL on prior admission to 27.3 mg/dL and remained elevated despite antimicrobial therapy. White blood cell count steadily improved over his hospitalization, and platelet count remained stable. Our patient ultimately received a tracheostomy and after 30 days of ICU stay was discharged to a long-term acute care hospital for further ventilator management.\nFig. 2 Electroencephalography. 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