COVID-19 and Neuromuscular Involvement: A Case Series and Brief Review of Literature

Katayoun Moradi; Bijan Forogh; Shahram Sadeghi; Mohammad Sadegh Khabbaz; Arezoo Attari; Fatemeh Sadat  Taghizadeh; Naseh Yousefi

doi:10.18502/jimc.v7i2.15051

Katayoun Moradi Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
Bijan Forogh Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
Shahram Sadeghi Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Mohammad Sadegh Khabbaz Guilan University of Medical Sciences, Rasht, Iran
Arezoo Attari Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
Fatemeh Sadat Taghizadeh Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
Naseh Yousefi Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/jimc.v7i2.15051

Keywords: COVID-19, Critical illness, Muscular diseases, Polyneuropathies, Polyradiculoneuropathy

Abstract

Background: Tough COVID-19 predominantly affects the respiratory tract, and extra-pulmonary manifestations, including neuromuscular complaints have been associated with this disorder. It is vital to monitor COVID-19 cases for the occurrence of Neuromuscular Disorders (NMDs), which could be overshadowed by severe respiratory and cardiovascular symptoms. In this study, we reported electrophysiological findings of a series of COVID-19 patients with complaints of paresthesia and weakness.

Methods: In this case series, the Electrodiagnostic studies (EDX) of 36 patients with recent complaints of weakness or paresthesia and a history of COVID-19 before symptoms were reported.

Results: 12 cases (33.3%) had abnormal EDX, five males and seven females, with a mean age of 51.42±11.49 years, history of hospitalization in five cases (41.7%), and ICU admission in four (33.3%). Seven cases were concluded as having a predominantly axonal type polyneuropathy (five sensory-motor and two sensory polyneuropathies). Of these seven, one was suggestive of Critical Illness Neuropathy (CIN). Three cases demonstrated a myopathic pattern with a history of ICU admission, hence the impression of Critical Illness Myopathy (CIM). In addition, one of these three, developed both myopathy and neuropathy and thus, is considered as having CIM/N. One case was diagnosed with Chronic Inflammatory Demyelinating Polyneuropathy (CIDP). The last case demonstrated an inflammatory involvement of lumbosacral roots (COVID-19-related radiculitis).

Conclusion: COVID-19 could be associated with a wide range of NMDs. In this study, the presence of axonal polyneuropathy, CIDP, and myopathy was demonstrated following SAR-COV-2 infection. Also, CIN/M was observed in COVID-19 patients with a history of ICU admission