key: cord-0886098-3asj8gon authors: Finsterer, J.; Scorza, Fulvio A. title: Fatalities of COVID-19 are rather attributable to multisystem inflammatory syndrome than infectious meningitis or sepsis date: 2021-04-15 journal: Indian J Med Microbiol DOI: 10.1016/j.ijmmb.2021.04.001 sha: 5f72d73775ccdfa3dcea80f4e9a9befb30999621 doc_id: 886098 cord_uid: 3asj8gon nan Fatalities of COVID-19 are rather attributable to multisystem inflammatory syndrome than infectious meningitis or sepsis With interest we read the article by Dharsandiya et al. about a 68yo male with severe COVID-19 complicated by multi-organ involvement, sepsis, and death [1] . We have the following comments. The main shortcoming is that the patient was diagnosed with meningo-encephalitis without documentation of an infectious agent. Spinal tap showed only mild pleocytosis (20/3). We should know if cerebro-spinal fluid (CSF) investigations were positive for SARS-CoV-2, if CSF was investigated for viruses other than SARS-CoV-2, and if CSF cultures were positive for bacteria, tuberculosis, or fungi. Missing is a cerebral MRI with contrast medium confirming the suspected meningoencephalitis. Given the reported data, it is conceivable that the patient rather experienced immune-encephalitis than infectious encephalitis. A second shortcoming is that no explanation for hyper-creatinekinase (CK)emia already on admission was provided. We should know if hyper-CKemia was due to seizures, myocardial infarction, myocarditis, or muscle injury prior to admission [2] . There are also indications that COVID-19 can be complicated by myositis, myopathy, or rhabdomyolysis [3, 4] . Unfortunately, follow-up CK values were not provided, why the further course of serum-CK remains undetermined. We do not agree with the diagnosis "viral sepsis". "Viral sepsis" requires per definition viremia. However, neither SARS-CoV-2 nor any other virus was found. Sepsis usually manifests with elevated C-reactive protein and pro-calcitonin but both parameters were normal, why the diagnosis "viral sepsis" remains questionable. Concerning the treatment, we should know the rationale for simultaneous anticoagulation and antithrombotic treatment (acetyl-salicylic acid). We should know the rationale for applying chloroquine, as it is ineffective for COVID-19. We should know which antiepileptics were given and if any drug caused side-effects. Missing are reference limits making the interpretation of the laboratory blood values difficult. CSF glucose of 137mg/dl suggests diabetes. Overall, the case report has a number of shortcomings, which should be addressed before diagnosing infectious meningo-encephalitis and sepsis. Statement of ethics was in accordance if ethical guidelines. No funding was received. JF: design, literature search, discussion, first draft, critical comments, final approval. Informed consent was obtained. The study was approved by the institutional review board. None. SARS-CoV-2 viral sepsis with meningoencephalitis Fulminant myocarditis in a COVID-19 positive patient treated with mechanical circulatory support -a case report SARS-CoV-2 myopathy SARS-CoV-2 associated rhabdomyolysis in 32 patients Acknowledgement none.