A rare post-COVID neurological complication: Case report of peripheral axonal sensory neuropathy

Abstract

The present outbreak of Severe Acute Respiratory Syndrome CoronaVirus-2 (SARS-CoV-2), a “novel coronavirus” with neurotropic potential, has presented with multiple cases of neurological manifestations also. SARS-CoV-2 infection is found to be associated with an increased incidence of diverse neurological manifestations such as hyposmia/anosmia, encephalopathy and encephalomyelitis, ischemic stroke and intracerebral hemorrhage, and neuromuscular diseases involving both central and peripheral nervous system. People with these severe complications were most likely elderly with medical comorbidities, especially hypertension and other vascular risk factors. However, in our case a 35-year-old young healthy man developed severe post-COVID neuropathy debilitating his daily activity further requiring rehospitalization. Our patient had developed severe SARS-CoV-2 pneumonia, with a computed tomography severity score of 18/25, needing non-invasive ventilation support, and intensive care unit care for a week, thereafter recovering well without complications and being discharged on room air. He had to be readmitted after 3 days in view of severe bilateral leg pain, being described as “pain crisis.” He was evaluated, a neurologist was involved in the case, with nerve conduction veloci (NCV) lower limbs revealing an axonal sensory neuropathy, which was treated with corticosteroid pulse therapy, gabapentin, and vitamin supplementation to which the patient responded well. Our case presented with pure sensory neuropathy post-COVID which is a rare presentation. The previous reports of treatment of SARS-CoV-2-associated neuropathy have also included corticosteroids and IVIG usually. Our patient improved with pulse therapy of corticosteroid and gabapentin. Thus, awareness and early treatment of peripheral neuropathy after SARS-CoV-2 is needed for good clinical outcomes.