Covid-19 Sonrası İlk Manik Atak İle Başvuran Tuberosklerozlu Hasta: Olgu Sunumu

Abstract

COVID-19’un pandemiye dönüşmesi sonrası hastalığın nöropsikiyatrik sistemler dahil birçok sistemi etkilediği ortaya çıkmıştır. Viral enfeksiyona ve verilen tedaviye bağlı depresyon, anksiyete, post travmatik stres bozuklukları ve az bir oranda psikoz görülebilmektedir. Tuberoskleroz de benzer şekilde epilepsi, mental retardasyon ve otizim gibi nöropsikiyatrik bulgular görülmesine rağmen eşlik eden bipolar bozukluk ve mani sonra derece nadir bildirilmiştir. Olgumuzun hem tuberoskleroz olması hem de COVID-19 sonrası ilk manik atağını geçirmesi nedeni ile sunulmuştur. Bilinen nöropsikiyatrik hastalığı olmayan 36 yaşında erkek hasta geçirdiği COVID-19 sonrası ilk manik atak nedeni ile dış merkezde antipsikotik tedavi alması sonrası ekstrapiramidal yan etkiler gelişmesi üzere hastanemize başvurdu. Cilt lezyonları ve beyin görüntüleri nedeni ile ek olarak tuberoskleroz tanısı konuldu. Olgunun medikal tedavisi sonrası semptomları kontrol altına alındı. COVID-19 sonrası ilk manik atağı ile gelen olgunun muhtemel etiyolojileri virüsün direk veya indirek etkisi, aldığı medikal tedavi veya tuberosklerozise bağlı durumlardı. Olgu, şikayetlerinin steroid sonrası ortaya çıkması, tedavisine antipsikotik ve duygudurum düzenleyici başladıktan 2 hafta sonra klinik bulgularının düzelmesi, ailesinde ve kendisinde geçirilmiş bipolar bozukluk öyküsü olmamasından dolayı steroid kullanımına bağlı ilk manik atak olarak değerlendirildi. Olgunun tuberoskleroz olması ve virüsün indirek etkileri gibi diğer sebepler yatkınlık sağlayan etkenler olarak düşünülmüştür. Olgumuz tuberoskleroz olan bir hastanın COVID-19 sonrası ilk manik atağını geçirmesi nedeni ile literatürdeki ilk vakadır. COVID-19 sonrası gelişen nöropsikiyatrik semptomların altında yatan etiyolojinin birçok nedene bağlı olabileceği akılda tutulmalıdır.

Keywords

• Bipolar
• COVID-19
• Manik Atak
• Psikozis
• Steroid
• Tuberoskleroz

The First Manic Episode Post-Covid-19 of A Patient with Tuberous Sclerosis: Case Report

Abstract

After the COVID-19 turned into a pandemic, it was revealed that the disease affected many systems, including neuropsychiatric systems. Depression, anxiety, post-traumatic stress disorder and psychosis depending on viral infection and medical therapy might be observed. Although neuropsychiatric diseases such as seizures, mental retardation and autism are seen in tuberous sclerosis, bipolar disorder and mania are very rarely reported together with tuberous sclerosis. A 36- year-old male patient with no known neuropsychiatric disease was admitted to our hospital with the development of extrapyramidal side effects after receiving antipsychotic treatment in the primary health care hospital due to his first manic episode after COVID-19. The patient was diagnosed with tuberous sclerosis owing to his skin lesions and cranial images. His symptoms were brought under control after medical therapy. Probable etiologies of the case coming with the first manic episode post- COVID-19, are direct or indirect effects of the virus, medical therapy(methylprednisolone) being applied, and/or factors depending on tuberous sclerosis. The patient was considered as the first manic episode due to steroids use because of the emergence of his complaints after steroids, improvement of clinical findings 2 weeks after the onset of antipsychotic and mood stabilizer treatment, and the absence of a medical history of bipolar disorder. Other causes such as tuberous sclerosis and indirect effects of the virus were considered as predisposing factors. Our case is the first case in the literature because a patient with tuberous sclerosis had his first manic episode after COVID-19. It should be kept in mind that the etiologies underlying psychotic symptoms which develop following COVID-19 may depend on several reasons.

Keywords

• : COVID-19
• Mania
• Steroids
• Tuberous Sclerosis

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