Cerebrospinal fluid positive for SARS-CoV-2 associated with neurological manifestations and proteome alterations in a multiple myeloma patient

Abstract Background Although SARS-CoV-2 infection is primarily associated with respiratory symptoms, neurological complications have been increasingly recognized, even in the absence of pulmonary involvement. Case presentation We report a case of a 67-year-old woman with a history of multiple myeloma and recent exposure to a COVID-19-positive individual who developed rapidly progressive neurological symptoms, including dysarthria, dysphagia, and hypoesthesia, without any respiratory manifestations. Her condition deteriorated to focal and dyscognitive status epilepticus, requiring mechanical ventilation. Brain MRI showed imaging features consistent with rhombencephalitis. SARS-CoV-2 infection was confirmed through positive qRT-PCR results from both nasopharyngeal swab and cerebrospinal fluid (CSF). Further analysis of the CSF using quantitative shotgun proteomics via mass spectrometry revealed a neuroinflammatory profile indicative of blood–brain barrier disruption and differential expression of several proteins relevant to brain function, including the major prion protein, superoxide dismutase 1 (SOD-1), and other aggregation-prone proteins. Conclusions This case supports the hypothesis that SARS-CoV-2 can invade the central nervous system and cause severe neurological impairment, even in the absence of typical respiratory symptoms. The findings underscore the importance of considering SARS-CoV-2 in the differential diagnosis of rapidly progressive neurological syndromes and highlight the need for further investigation into the mechanisms of neuroinvasion and the potential neurotropism of emerging viral variants.