Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 12 2021 12 15 747 750 Minoosh Moghimi Department of Medical Hematology and Oncology, Vali-e-Asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran. AND School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran Samad Ghodrati School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. AND Department of Pulmonology, Vali-e-Asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran Zahra Abbaspourrad School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. AND Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran. Amirhossein Moghtader Mojhdehi School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. AND Department of Infectious Diseases, Vali-e-Asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran Sattar Jafari School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. AND Department of Gastroenterology, Vali-e-Asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran Reza Mansouri Department of Medical Hematology and Oncology, Vali-e-Asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran. AND School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. Kasra Khodadadi Department of Medical Hematology and Oncology, Vali-e-Asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran. AND School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. ANDDepartment of Internal Medicine, Vali-e-Asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran Muhammmad Javad Muhammmadi Department of Medical Hematology and Oncology, Vali-e-Asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran . AND School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. Negin Parsamanesh Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran 2021 02 20 2021 08 10 The novel corona virus infection involve both Central & Peripheral Nervous System. Some of the presentations include: acute cerebrovascular disease, impaired consciousness, transverse myelitis, encephalopathy, encephalitis and epilepsy. Our patient was 78 year –old man with dementia and diabetic nephropathy which was admitted two times for possibly COVID-19 infection. At the first hospitalization, the patient is treated with hydroxychloroquine and kaletra based on clinical symptoms and initial laboratory findings due to suspicion of COVID-19. After the negative RT-PCR test of nasopharyngeal sample for COVID-19 and evidence of aspiration pneumonia in CT scan, the patient was discharged with oral antibiotics. Five weeks later, he was rehospitalized with loss of consciousness, fever and hypoxemia in physical exam he had neck stiffness in all directions, So the central nervous system (CNS) infection was suspected, the cerebrospinal fluid (CSF) sample was in favor of aseptic meningitis and second RT-PCR test of nasopharyngeal sample for COVID-19 was positive but Brain MRI just showed small vessel disease without evidence of encephalitis. In the second hospitalization, he had acute renal failure, which was treated with supportive care, and also suffered from pulmonary embolism with cavitary lesions in his lungs. Meningitis with pulmonary embolism and acute renal failure have not yet reported. Our patient is the first one, so we decided to share it. This case showed different presentation of COVID-19 without typical lung involvement. So we must pay attention to any sign & symptoms in a patient suspected of having a COVID-19. https://acta.tums.ac.ir/index.php/acta/article/view/9180