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Peer-reviewedCC BYNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology

Cerebrospinal fluid positive for SARS-CoV-2 associated with neurological manifestations and proteome alterations in a multiple myeloma patient.

  • Jayr Schmidt-Filho1,2
  • Thais Rodrigues B Geraldo3
  • Victor C Carregari4
  • Marina de Mattos Nascimento1,2
  • Anita Cassoli Cortez1,2
  • Ramon Teixeira Costa5
  • Ivan Leonardo Avelino Franca-Silva6
  • Israel Tojal da Silva7
  • Marcos Aurélio Peterlevitz3
  • Alessandro S Farias8,9
  • José Eduardo Vitorino Galon3
  • Ana Maria Fraga10
9 more authors
  • Celso Francisco Hernandes Granato10
  • Gislaine Cristina Lopes Machado Porto11
  • Diana Noronha Nunes12,13,14
  • Dirce Maria Carraro15
  • Kenneth J Gollob16,17,18
  • Emmanuel Dias-Neto12,13,14
  • Daniel Martins-de-Souza4,8,16,19,20,21
  • Vilma R Martins19,20,21
  • Marjorie Vieira Batista22,23,24
24 affiliations
  1. 1Department of Hematology and Cell Therapy, A.C.Camargo Cancer Center, São Paulo, SP, Brazil.
  2. 2Reference Center for Hematologic Neoplasms at the A.C.Camargo Cancer Center, São Paulo, Brazil.
  3. 3Department of Neurology, A.C.Camargo Cancer Center, São Paulo, Brazil.
  4. 4Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil.
  5. 5Intensive Care Unit, A.C.Camargo Cancer Center, São Paulo, Brazil.
  6. 6Department of Infectious Diseases and Infection Control, A.C.Camargo Cancer Center, R. Prof. Antônio Prudente, 211 - Liberdade, São Paulo, SP, 01509-010, Brazil.
  7. 7Laboratory of Computational Biology, A.C.Camargo Cancer Center, São Paulo, Brazil.
  8. 8Experimental Medicine Research Cluster (EMRC), University of Campinas (UNICAMP), Campinas, SP, Brazil.
  9. 9Autoimmune Research Laboratory, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil.
  10. 10Laboratory of Virology, Grupo Fleury, São Paulo, Brazil.
  11. 11Department of Imaging, A.C.Camargo Cancer Center, São Paulo, Brazil.
  12. 12Laboratory of Medical Genomics, A.C.Camargo Cancer Center, São Paulo, Brazil.
  13. 13Rutgers Cancer Institute, Newark, USA.
  14. 14Division of Cancer Biology, Department of Radiation Oncology, Rutgers New Jersey Medical School, Newark, USA.
  15. 15Translational Immuno-oncology Group, International Research Center, A.C. Camargo Cancer Center, São Paulo, Brazil.
  16. 16D'Or Institute for Research and Education (IDOR), São Paulo, Brazil.
  17. 17Translational Immuno-oncology Laboratory, Hospital Israelita Albert Einstein, São Paulo, Brazil.
  18. 18Center for Research in Immuno-oncology (CRIO), Hospital Israelita Albert Einstein, São Paulo, Brazil.
  19. 19INCT in Modelling Human Complex Diseases With 3D Platforms (Model3D), São Paulo, Brazil.
  20. 20Department of Cell Biology and Development, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.
  21. 21National Institute of Science and Technology in Oncogenomic and Pharmaceutical Innovation, São Paulo, Brazil.
  22. 22Reference Center for Hematologic Neoplasms at the A.C.Camargo Cancer Center, São Paulo, Brazil. [email protected].
  23. 23Intensive Care Unit, A.C.Camargo Cancer Center, São Paulo, Brazil. [email protected].
  24. 24Department of Infectious Diseases and Infection Control, A.C.Camargo Cancer Center, R. Prof. Antônio Prudente, 211 - Liberdade, São Paulo, SP, 01509-010, Brazil. [email protected].
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Abstract

Background

Although SARS-CoV-2 infection is primarily associated with respiratory symptoms, neurological complications have been increasingly recognized, even in the absence of pulmonary involvement.Case presentation

We report a case of a 67-year-old woman with a history of multiple myeloma and recent exposure to a COVID-19-positive individual who developed rapidly progressive neurological symptoms, including dysarthria, dysphagia, and hypoesthesia, without any respiratory manifestations. Her condition deteriorated to focal and dyscognitive status epilepticus, requiring mechanical ventilation. Brain MRI showed imaging features consistent with rhombencephalitis. SARS-CoV-2 infection was confirmed through positive qRT-PCR results from both nasopharyngeal swab and cerebrospinal fluid (CSF). Further analysis of the CSF using quantitative shotgun proteomics via mass spectrometry revealed a neuroinflammatory profile indicative of blood-brain barrier disruption and differential expression of several proteins relevant to brain function, including the major prion protein, superoxide dismutase 1 (SOD-1), and other aggregation-prone proteins.Conclusions

This case supports the hypothesis that SARS-CoV-2 can invade the central nervous system and cause severe neurological impairment, even in the absence of typical respiratory symptoms. The findings underscore the importance of considering SARS-CoV-2 in the differential diagnosis of rapidly progressive neurological syndromes and highlight the need for further investigation into the mechanisms of neuroinvasion and the potential neurotropism of emerging viral variants.

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Cite

BibTeXRIS
BibTeX
@article{schmidtfilho2026cerebrospinal,
  title = {{Cerebrospinal fluid positive for SARS-CoV-2 associated with neurological manifestations and proteome alterations in a multiple myeloma patient.}},
  author = {Jayr Schmidt-Filho and Thais Rodrigues B Geraldo and Victor C Carregari and Marina de Mattos Nascimento and Anita Cassoli Cortez and Ramon Teixeira Costa and Ivan Leonardo Avelino Franca-Silva and Israel Tojal da Silva and Marcos Aurélio Peterlevitz and Alessandro S Farias and José Eduardo Vitorino Galon and Ana Maria Fraga and Celso Francisco Hernandes Granato and Gislaine Cristina Lopes Machado Porto and Diana Noronha Nunes and Dirce Maria Carraro and Kenneth J Gollob and Emmanuel Dias-Neto and Daniel Martins-de-Souza and Vilma R Martins and Marjorie Vieira Batista},
  journal = {Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology},
  year = {2026},
  month = oct,
  doi = {10.1007/s10072-026-09471-w},
  url = {https://europepmc.org/article/MED/42894086},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Cerebrospinal fluid positive for SARS-CoV-2 associated with neurological manifestations and proteome alterations in a multiple myeloma patient.
AU  - Jayr Schmidt-Filho
AU  - Thais Rodrigues B Geraldo
AU  - Victor C Carregari
AU  - Marina de Mattos Nascimento
AU  - Anita Cassoli Cortez
AU  - Ramon Teixeira Costa
AU  - Ivan Leonardo Avelino Franca-Silva
AU  - Israel Tojal da Silva
AU  - Marcos Aurélio Peterlevitz
AU  - Alessandro S Farias
AU  - José Eduardo Vitorino Galon
AU  - Ana Maria Fraga
AU  - Celso Francisco Hernandes Granato
AU  - Gislaine Cristina Lopes Machado Porto
AU  - Diana Noronha Nunes
AU  - Dirce Maria Carraro
AU  - Kenneth J Gollob
AU  - Emmanuel Dias-Neto
AU  - Daniel Martins-de-Souza
AU  - Vilma R Martins
AU  - Marjorie Vieira Batista
PY  - 2026
DA  - 2026/10/19
JO  - Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
DO  - 10.1007/s10072-026-09471-w
UR  - https://europepmc.org/article/MED/42894086
AB  - Background  Although SARS-CoV-2 infection is primarily associated with respiratory symptoms, neurological complications have been increasingly recognized, even in the absence of pulmonary involvement.Case presentation  We report a case of a 67-year-old woman with a history of multiple myeloma and recent exposure to a COVID-19-positive individual who developed rapidly progressive neurological symptoms, including dysarthria, dysphagia, and hypoesthesia, without any respiratory manifestations. Her condition deteriorated to focal and dyscognitive status epilepticus, requiring mechanical ventilation. Brain MRI showed imaging features consistent with rhombencephalitis. SARS-CoV-2 infection was confirmed through positive qRT-PCR results from both nasopharyngeal swab and cerebrospinal fluid (CSF). Further analysis of the CSF using quantitative shotgun proteomics via mass spectrometry revealed a neuroinflammatory profile indicative of blood-brain barrier disruption and differential expression of several proteins relevant to brain function, including the major prion protein, superoxide dismutase 1 (SOD-1), and other aggregation-prone proteins.Conclusions  This case supports the hypothesis that SARS-CoV-2 can invade the central nervous system and cause severe neurological impairment, even in the absence of typical respiratory symptoms. The findings underscore the importance of considering SARS-CoV-2 in the differential diagnosis of rapidly progressive neurological syndromes and highlight the need for further investigation into the mechanisms of neuroinvasion and the potential neurotropism of emerging viral variants.
SN  - 1590-1874
SN  - 1590-3478
ER  -