Dados do Trabalho

Título

An inflammatory lumbar radiculoplexopathy pos severe covid-19 infection associated with heterotopic ossification

RESUMO

INTRODUCTION
Neurological complications due to covid-19 infection have been linked to severe cases of COVID-19 infection since the onset of the pandemic. However, the clinical and pathophysiological characterization of peripheral nervous system involvement is still unclear.
METHODS
We describe a case report of a 57 years old man, previously healthy, who presented an asymmetric lumbar radiculoplexitis after a severe presentation of COVID-19 infection responsive to corticotherapy.
RESULTS
In December of 2020, the patient was admitted to the hospital with a respiratory failure related to covid-19 infection. He was intubated and placed on ECHMO for 26 days. During this time, the patient had 3 secondary infections, multiple blood transfusions, and drug-induced hepatitis. He was tracheostomized and in February of 2021, after sedation was removed, the patient was quadriplegic and arreflexia, and the diagnosis of critical ill polyneuropathy was made. In the following months, the patient was under rehabilitation, but no motor improve was noted on the left foot. In September 2021 came to our peripheral neuropathy center. At physical examination, the patient presented a plegia on the left foot with areflexia on left Achilles tendon.
The nerve conduction study and the EMG showed an important partial axonal involvement of the left tibial and peroneal nerves with few functioning motor units. Partial axonal involvement of the right peroneal nerve Lumbosacral MRI with neurography showed signs of inflammation in the roots of L4 to S1 and hyperintensity in T2 STIR with gadolinium enhancement bilaterally, but more intensive on the left, with extension to left sciatic nerve. A heterotopic ossification was identified between the left gluteus minimums muscle.
Heterotopic ossification on left iliac cortical bone related to the previous hospitalization period with edema located in the deep muscle fibers of the left gluteus minimums. Inflammatory edema affecting the soft tissues between the iliotibial tract and the greater femoral trochanter bilaterally, as well as the insertional portions of the gluteus minimus and medius, being slightly more evident on the right, may correspond to a change related to friction/pressure by decubitus. Signs of neuropathy/neuritis of L4 to S1 bilaterally more evident on the left.
CONCLUSIONS
Severe cases of COVID-19 infection can lead to an inflammatory presentation of the peripheral nervous system as a radiculoplexitis presented here.

Palavras Chave

covid-19;peripheral nervous system;radiculoplexopathy