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Título

COVID-19 INDUCED NEUROPATHY

RESUMO

Case presentation: Male patient, 35 years old, hipertensive and obese, was addimited in ICU by COVID-19 infection, spending 14 days intubated and 7 days in the ward. While in the hospital, the patient started to feel lower limb weakness, paresthesia and neuropathic pain, which until the day he was discharged the symptoms were assigned to be related by both collateral effects of medications administered and the time he spent at the ICU itself. Already at home the lower limb weakness got worse, especially in the proximal musculature of the right leg (iliopsoas and quadriceps). Thus, was solicited an electroneuromyography that showed serious injury and prominent denervation of both right femoral and left sciatic nerve, in addition to sensory axonal polyneuropathy in the lower limbs, post COVID-19. Therefore treatment was started with pulse therapy of 1g methylprednisolone for 5 days and pregabalin with progression up to 150mg 12/12h. Upon return, the patient reports improvement in neuropathic pain and paresthesia, but maintains a motor deficit in the lower limbs. The electroneuromyography was repeated, which showed signs of femoral and sciatic reinnervation, but still with severe injury in these nerves. Discussion: COVID-19 is a disease with tropism for the respiratory system, but as a reflection of serious infections by SARS-COV-2, patients can develop neurological deficits, such as motor and sensory ones. Among the main pathophysiological mechanisms hypotheses are: ischemic phenomena; development of autoimmunity; and the neuropathy of the critically ill patient. Thus, the development of neuropathy as a symptom of COVID-19 is reinforced by the temporal relationship with the onset of the disease and by the absence of other factors that could predispose to this condition, such as diabetes mellitus or Guillain-Barré syndrome. Final comments: A rare case of neurological manifestation of COVID-19 was presented here, which differs from the pattern of neuropathies caused by other viruses, which usually have a distal polyneuropathy pattern with sensory predominance. Thus, it is important for health care professionals to be alert for manifestations similar to those described in this case, as well as other possible neurological manifestations caused by SARS-COV-2. Finally, treatment with pulse therapy of methylprednisolone, pregabalin, and physical therapy showed some degree of efficacy in improving the condition.

Palavras Chave

Área

Neuropatias Periféricas