Neuroinvasive potential of human coronavirus OC43: case report of fatal encephalitis in an immunocompromised host

Neurologic manifestations of COVID-19 include anosmia, ageusia, encephalopathy, agitation, confusion, ischemic strokes, Guillain–Barré syndrome, seizures, and hemorrhagic encephalitis. Although mechanisms of central nervous system (CNS) injury are likely diverse, direct viral invasion of the CNS has been demonstrated in case reports. Neurotropism of human coronaviruses (HCoVs) is therefore of great interest in the context of the COVID-19 pandemic. Here we present an autopsy-proven case of fatal human coronavirus (HCoV)-OC43 encephalitis in an infant with aplastic thymus and chronic T-cell lymphopenia. Clinicians should remain alert to the possibility of direct CNS invasion by human coronaviruses, including the novel pandemic SARS-CoV-2.