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Título

PERIPHERAL POLYNEUROPATHY AFTER COVID-19 INFECTION: A CASE REPORT

RESUMO

Case Report Patient, 42 years old, male, no comorbidities, attended at an outpatient neurosurgery service complaining of burning pain in the plantar region of both feet, a condition that started after 3 months of mild infection of the airways by COVID-19. On physical examination, bilateral symmetrical paraparesis was identified, and a grade 3 strength rating for plantar flexion and dorsiflexion and for hip flexion-extension. Was also identified change in orthostatism and in the stimulation of ambulation, with balance deficit due to alteration in proprioception. Paresthesia in both heels and distal phalanx of the hallux in both feet. Also reported intense pain in both lower limbs, graded in 10 on the visual analogue pain scale. The current clinical condition directly affects their work and daily life activities. Was reported previous use of opioids to control symptoms, being refractory to treatment and without improvement. With the progressive worsening of the clinical condition and considering that the patient has a significant kinetic-functional deficit, treatment with antidepressants and anticonvulsants at optimized doses and spinal electrode treatment was indicated for neuropathic pain. Discussion The post-COVID-19 syndrome brought with it peripheral polyneuropathy. One of the main symptoms reported by patients who suffer from this syndrome is pain, which can be associated with several other systemic disorders. The wide range of neurological manifestations resulting from the immune response to the virus has led to studies on the pathophysiology of this it. The main mechanism associated with the onset of this varied condition is associated with the invasion of the blood-brain barrier by the virus, in addition to the systemic pro-inflammatory action due to the release of numerous cytokines. Peripheral polyneuropathies in patients post-COVID-19 are frequent and associated not only with toxicity resulting from immunological aspects, but also due to the neurotoxic action of the main drugs used to combat the disease. It was noted that COVID-19 does not have a direct influence on the peripheral nerve branches, and no infectious neuropathy caused by this virus were established. Final Comments In view of the cases already reported in the literature and the frequency of neurological complaints after COVID-19 infection, there is a relevance of these studies for future clarifications on the subject and treatment measures for it.

Palavras Chave

Peripheral polyneuropathy, post-COVID-19 neuropathic pain, neuropathic pain