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

Yıl 2021, Cilt: 1 Sayı: 1, 18 - 25, 27.12.2021

Ahmet Buğrul Ayşegül Metin Sena Karaca , Zehra Avan Nazmiye Kaya

Öz

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.

Anahtar Kelimeler

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

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

Öz

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.

Anahtar Kelimeler

: COVID-19, Mania, Steroids, Tuberous Sclerosis

Kaynakça

• Alcock, J., & Masters, A. (2021). Cytokine storms, evolution and COVID-19. Evolution, Medicine, and Public Health, 9(1), 83-92.
• Arbour, N., Day, R., Newcombe, J., & Talbot, P. J. (2000). Neuroinvasion by human respiratory coronaviruses. Journal of Virology, 74(19), 8913-8921.
• Baig, A. M., Khaleeq, A., Ali, U., & Syeda, H. (2020). Evidence of the COVID-19 virus targeting the CNS: Tissue distribution, host-virus interaction, and proposed neurotropic mechanisms. ACS Chemical Neuroscience, 11(7), 995-998.
• Brown, E., Gray, R., Monaco, S. L., O’Donoghue, B., Nelson, B., … McGorry, P. (2020). The potential impact of COVID-19 on psychosis: A rapid review of contemporary epidemic and pandemic research. Schizophrenia Research, 222, 79-87. https://doi.org/10.1016/j.schres.2020.05.005
• Chopra, V. K., Cintury, Y., & Sinha, V. K. (2006). Bipolar disorder associated with tuberous sclerosis: Chance association or aetiological relationship? Indian Journal of Psychiatry, 48(1), 66-68. https://doi.org/10.4103/0019-5545.31624
• de Sousa-Moreira, J. L., Barbosa, S. M. B., Vieira, J. G., Chaves, N. C. B., Felix, E. B. G., … Neto, M. L. R. (2021). The psychiatric and neuropsychiatric repercussions associated with severe infections of COVID-19 and other coronaviruses. Progress in Neuro-psychopharmacology & Biological Psychiatry, 106, 110159. https://doi.org/10.1016/j.pnpbp.2020.110159
• Dubovsky, A. N., Arvikar, S., Stern, T. A., & Axelrod, L. (2012). The neuropsychiatric complications of glucocorticoid use: Steroid psychosis revisited. Psychosomatics, 53(2), 103-115. https://doi.org/10.1016/j.psym.2011.12.007
• Gupta, P., & Haria, J. (2015). Tuberous sclerosis with bipolar disorder mania: Genetic perspective. Acta Medica International, 2(2), 191.
• Haq, M. Z. U. I., Dubey, I., Khess, C. R. J., Das, U., & Kumar, R. (2009). Bipolar disorder and tuberous sclerosis complex: Is it a mere coincidence? CNS Spectrums, 14(11), 643-647.
• Mawhinney, J. A., Wilcock, C., Haboubi, H., & Roshanzamir, S. (2020). Neurotropism of SARS-CoV2: COVID-19 presenting with an acute manic episode. BMJ Case Reports, 13(6). https://doi.org/10.1136/bcr-2020-236123
• Mehta, P., McAuley, D. F., Brown, M., Sanchez, E., Tattersall, R. S. … Manson, J. J. (2020). COVID19: Consider cytokine storm syndromes and immunosuppression. Lancet, 395(10229), 1033- 1034. https://doi.org/10.1016/s0140-6736(20)30628-0
• Proudfoot, J., Doran, J., Manicavasagar, V., & Parker, G. (2011). The precipitants of manic/hypomanic episodes in the context of bipolar disorder: A review. Journal of Affective Disorders, 133(3), 381- 387.
• Rogers, J. P., Chesney, E., Oliver, D., Pollak, T. A., McGuire, P., … David, A. S. (2020). Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: A systematic review and meta-analysis with comparison to the COVID-19 pandemic. The Lancet Psychiatry, 7(7), 611-627. https://doi.org/10.1016/S2215-0366(20)30203-0
• Severance, E. G., Dickerson, F. B., Viscidi, R. P., Bossis, I., Stallings, C. R., … Yolken, R. H. (2011). Coronavirus immunoreactivity in individuals with a recent onset of psychotic symptoms. Schizophrenia Bulletin, 37(1), 101-107. https://doi.org/10.1093/schbul/sbp052
• Shekhawat, J., Gauba, K., Gupta, S., Purohit, P., Mitra, P., … Banerjee, M. (2021). Interleukin-6 perpetrator of the COVID-19 cytokine storm. Indian Journal of Clinical Biochemistry, 36(4), 1- 11. https://doi.org/10.1007/s12291-021-00989-8
• Steardo, L., & Verkhratsky, A. (2020). Psychiatric face of COVID-19. Translational Psychiatry, 10(1), 1-12.
• Tomonaga, K. (2004). Virus-induced neurobehavioral disorders: Mechanisms and implications. Trends in Molecular Medicine, 10(2), 71-77.
• WHO. (2021). Coronavirus (COVID-19) dashboard. https://covid19.who.int/