DISINTEGRATION OF THE SELF SYSTEM IN A PATIENT WITH SEMANTIC VARIANT PPA (SVPPA) DIAGNOSED FOLLOWING SARS-COV-2 INFECTION AND COVID-19

The aim of this study is to present a patient with semantic variant PPA (svPPA) diagnosed following SARS-CoV-2 infection and COVID-19 contraction, who experienced a dramatic disintegration of the Self system.The patient, a 45-year-old bilingual physician with no chronic diseases, contracted SARS-CoV-2 in November 2020, confirmed by RT-PCR. During acute COVID-19, he developed high fever (40C) and neurological symptoms such as severe headache, dizziness, confusion, and loss of smell. About 16 weeks later, he had difficulties understanding common words in Polish and English (he was bilingual). One year post-COVID-19, his language impairment has intensified affecting word comprehension and naming. His syntax and phonology in Polish remained relatively intact, but he appeared confused. Despite losing word meaning, he could still use various objects. Psychiatric examination showed no mental illness, while neurological and neuropsychological assessments revealed long COVID with predominant aphasia symptoms. He had problems with lexical classification and higher-level differentiation. A MRI one year after COVID-19 showed significant asymmetric cortical atrophy in the temporal regions, predominantly on the left side, and in subcortical areas. In the Polish Boston Naming Test (BNT), he had difficulty recalling well-known items and used general descriptions instead (the patient occasionally mixed Polish and English). In the Pyramids and Palm Trees Test (PPTT) we found impairment of semantic memory. Surface dyslexia and dysgraphia were also found. Working memory impairment increased as the disease progressed. Information flow was profoundly disturbed, and ERPs to all stimuli significantly reduced. Two years after contracting COVID-19, the patient exhibited significant loss of object knowledge and constructional apraxia. He developed blank speech, making incoherent statements. As the disease progressed the patient lost his sense of identity, unable to recognize objects or faces, including his reflection. In June 2023, just over two and a half years after contracting COVID-19, the patient developed pneumonia. He was hospitalized and died a few days later. Post-mortem examinations revealed asymmetric cortical atrophy of the temporal lobes, more severe in the left hemisphere, which is associated with language functions. TDP-43 proteinopathy was also diagnosed. We will discuss the multifaceted symptoms and significance of this case study for modern medicine.This reliably documented case serves as a significant contribution to modern neuroscience, offering valuable insights into the intersection of COVID-19 and neurodegenerative diseases, and paving the way for future research and improved patient care.