Daniel A. Ruiz, MD
Resident Physician
Emory Physical Medicine & Rehabilitation
Atlanta, Georgia, United States
Samuel B. Milton, III, MD
Assistant Professor
ERH
ALPHARETTA, Georgia, United States
A 72-year-old female with a history of hypertension, osteoporosis, leukopenia, and breast cancer presented to the hospital with urinary retention and constipation for one month along with 2 weeks of progressive ascending lower extremity paresthesias and weakness. She was diagnosed with COVID-19 ten weeks prior to initial presentation.
After extensive neurologic/rheumatologic workup including EMG, lumbar puncture, imaging, and serum studies, the patient was diagnosed with COVID-19 tractopathy. She underwent IVIG and IV steroid treatment with no improvement until a 7-session plasmapheresis course.
The patient arrived to an inpatient rehabilitation unit, paraplegic. After an 18-day stay, symptoms & functionality improved with left/right discrimination and bowel control slowly returning. She was discharged from the rehab unit to a SNF with Foley in place and follow-up with neurology and urology.
Discussions: COVID-19 has been observed to have a wide range of neurological manifestations. In this case, the temporal relationship between COVID-19 infection and the onset of neurological symptoms, combined with diagnostic testing for GBS, Lyme disease, lupus, and nutritional deficiencies, supports a diagnosis of COVID-19 tractopathy. MRI imaging showed scattered thoracic multifocal T2 hyperintensities and dorsal cord signal abnormalities, atypical in viral myelitis. Several cases of COVID-19 tractopathy have been described in the literature with deficits similar to this patient, although usually arising 2-6 weeks earlier than this case. Select cases reported early improvement during patients’ stay at inpatient rehab facilities, with most regaining ambulatory function within 6 months to 1 year.
Conclusions: COVID-19 can lead to devastating neurological complications. Early recognition, treatment with immunomodulatory therapies, and inpatient rehabilitation therapy may improve patient outcomes. Further research could help explain the underlying pathophysiology and optimize management strategies for COVID-19-associated neurological syndromes. This case adds to the growing body of research that highlights the diverse and life-altering manifestations of COVID-19 beyond the respiratory system.
