SARS-CoV-2 may play a direct role in the pathogenesis of posterior reversible encephalopathy syndrome (PRES) associated with COVID-19: a case report and literature review

Abstract Background: During the past three years of the COVID-19 pandemic, COVID-19 has been recognized to cause various neurological complications, including rare posterior reversible encephalopathy syndrome (PRES). However, it remains controversial whether infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or widely coexisting known factors of PRES such as hypertension, acute kidney injury, and the use of immunosuppressants in COVID-19 patients play the main role in the pathogenesis of PRES associated with COVID-19. Case presentation: Here we report a case of PRES in an 18-year-old female with mild SARS-CoV-2 infection who had no known factors related to PRES. We also conducted a literature search using PubMed for similar cases of PRES associated with COVID-19 and summarized the clinical characteristics of these patients. Conclusions: These cases strongly suggest that among the numerous factors that may trigger PRES in COVID-19, the infection itself may be one of the core factors.