Autonomic dysfunction heralding acute motor axonal neuropathy in COVID-19
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CASE REPORT
Autonomic dysfunction heralding acute motor axonal neuropathy in COVID-19 Ritwik Ghosh 1 & Dipayan Roy 2 & Samya Sengupta 3 & Julián Benito-León 4,5,6 Received: 22 June 2020 / Revised: 14 July 2020 / Accepted: 28 August 2020 # Journal of NeuroVirology, Inc. 2020
Abstract Albeit primarily a disease of respiratory tract, the 2019 coronavirus infectious disease (COVID-19) has been found to have causal association with a plethora of neurological and neuropsychological effects. However, the pathogenesis of COVID-19-induced neurological manifestations is still in its infancy. Autonomic dysfunction preceding acute motor axonal neuropathy (AMAN) has not been yet associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We herein report one patient who developed acute onset dysautonomia heralding AMAN during SARS-CoV-2 infection. Keywords Autonomic dysfunction . Acute motor axonal neuropathy . COVID-19 . SARS-CoV-2
Physicians are seeing increasingly more patients with a spectrum of neurological manifestations associated with coronavirus disease 2019 (COVID-19) (Ghosh et al. 2020; GutiérrezOrtiz et al. 2020; Rábano-Suárez et al. 2020; Roy et al. 2020). However, the pathogenesis of COVID-19-induced neurological manifestations is still in its infancy. Autonomic dysfunction preceding acute motor axonal neuropathy (AMAN) has not been yet associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We herein report one patient who developed acute onset dysautonomia heralding AMAN during SARS-CoV-2 infection. Case report A 20-year-old man was admitted to the emergency room with rapidly progressive weakness of all four limbs * Julián Benito-León [email protected] 1
Department of General Medicine, Burdwan Medical College & Hospital, Burdwan, West Bengal, India
2
Department of Biochemistry, AIIMS Jodhpur, Jodhpur, Rajasthan, India
3
Department of General Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
4
Department of Neurology, University Hospital “12 de Octubre”, Madrid, Spain
5
Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
6
Department of Medicine, Complutense University, Madrid, Spain
over a period of 3 days. His past medical history was unremarkable. Eight days prior to his admission, he had developed a mild fever, sore throat, and generalized malaise. He also complained of intermittent severe dizziness, profuse sweating, constipation, erectile dysfunction, and a feeling of shivering cold and central chest discomfort since last 5 days. On physical examination, he was fully awake, conscious, anxious, afebrile, hypertensive (recorded supine blood pressure was 180/96 mm of Hg), and tachycardic. Postural drop of blood pressure was noted when he was made to stand up from supine recumbent position with support. His respiratory rate was 16/min and oxygen saturation of 98% in room air. Bedside electrocardiogram monitoring showed loss of sinus arrhythmia without any ischemic c
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