Case Series: Post-COVID Small Fiber Neuropathy
Neurology
; 98(18 SUPPL), 2022.
Artigo
em Inglês
| EMBASE | ID: covidwho-1925382
ABSTRACT
Objective:
To report a case series documenting biopsy-proven small fiber neuropathy (SFN) after COVID-19.Background:
Patients recovering from COVID-19 who present with sensory as well as autonomic symptoms, including positional orthostatic tachycardia syndrome (POTS), frequently have negative electrodiagnostic testing. Skin biopsy may be required to reveal SFN. Design/Methods:
This is a retrospective case series of patients seen in the Yale Neurology COVID-19 Clinic with positive SARS-CoV-2 PCR or antibody or a clinically consistent illness. After laboratory testing and a negative nerve conduction study, all patients underwent skin biopsy to test for intraepidermal SFN. Case 1 A 40F with pre-diabetes (HbA1c 6.2%) developed burning, numbness, and tingling in the hands and legs and POTS 6 weeks after acute COVID-19. Skin biopsy demonstrated non-length dependent SFN. Complete remission of neuropathy symptoms occurred within days of intravenous immunoglobulin (IVIG) therapy, which has been continued longitudinally. Case 2 A 65F with non-insulin dependent diabetes (HbA1c 8.0%) developed excruciating burning pain in her feet and orthostasis within weeks of acute COVID-19. Skin biopsy demonstrated non-length dependent SFN. She experienced partial relief of symptoms after IVIG and gabapentin. Case 3 A 43F with pre-diabetes (HbA1c 6.0%) developed orthostasis, numbness, paresthesias, and a “sunburned” feeling in her face, back, hands, and feet 2 weeks after acute COVID-19. Skin biopsy demonstrated length-dependent SFN. Symptoms improved over several months of pregabalin treatment, but have not resolved. The patient deferred immunotherapy. Case 4 A 40M developed POTS, numbness, and paresthesias in his face and left leg up to the knee within weeks of a clinical COVID-19 illness. Skin biopsy demonstrated non-length dependent SFN. IVIG therapy has resulted in significant improvement in symptoms.Conclusions:
Sensory symptoms and POTS occur post-COVID, and SFN should be considered in the differential. Given the time of onset and response to immunotherapy, post-COVID SFN may have an underlying autoimmune etiology.
gabapentin; hemoglobin A1c; human immunoglobulin; pregabalin; adult; burn; case study; conference abstract; coronavirus disease 2019; drug therapy; female; foot; human; hypesthesia; immunotherapy; impaired glucose tolerance; intravenous drug administration; knee; laboratory test; male; nerve conduction; neurology; neuropathy; non insulin dependent diabetes mellitus; nonhuman; pain; paresthesia; postural orthostatic tachycardia syndrome; remission; retrospective study; Severe acute respiratory syndrome coronavirus 2; skin biopsy; small fiber neuropathy; standing
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Coleções:
Bases de dados de organismos internacionais
Base de dados:
EMBASE
Tópicos:
Covid persistente
Idioma:
Inglês
Revista:
Neurology
Ano de publicação:
2022
Tipo de documento:
Artigo
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