Abulia major and hypoactive delirium in COVID-19 reversed with methylprednisolone pulse therapy

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Abstract Background: Sars-CoV-2 is a member of the genus Betacoronavirus like the two other coronaviruses viz. SARS-CoV (severe acute respiratory syndrome coronavirus) and MERS-CoV (Middle East respiratory syndrome coronavirus). SARS-CoV-2 infection has been associated with neuropsychiatric manifestations in acute and chronic COVID-19 (long COVID-19 syndrome), resulting in social consequences and worsening people's quality of life. Case description: This article is a scenario of two cases of neurological manifestations resulting from infection by SARS-CoV-2 that were reversed with methylprednisolone in a pulse therapy regimen. The first case presents a young patient with symptoms similar to those existing in patients with Alzheimer's and Parkinson's diseases, whose final and presumable diagnosis was Abulia major. The second case exemplifies an elderly person admitted to the hospital due to hypoactive delirium triggered by a urinary tract infection hypothesis. The final diagnosis was hypoactive delirium secondary to COVID-19, with urinary manifestations from SARS-CoV-2 kidney injury. Discussion/Conclusion: The purpose of this article is to warn about phenomena related to COVID-19, whose treatment can be performed with high doses of corticosteroids and with drugs that act positively on dopaminergic and serotonergic pathways. Patient exams and more information are available in the Appendix of this article.

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