A Case of Autoimmune Small Fiber Neuropathy as Possible Post COVID Sequelae

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is reported to induce and augment autoimmune processes. Moreover, postinfectious effects of coronavirus disease 2019 (COVID-19) are still poorly understood and often resemble symptoms of the acute infection phase. A patient with swollen extremities was presented to the Department of Angiology at the Medical University of Vienna with complaints of muscle and joint pain, paresthesia, and arterial hypertension with intense headache. Prior to these complaints, she had been suffering from various symptoms since November 2020, following a SARS-CoV-2 infection in the same month. These included recurrent sore throat, heartburn, dizziness, and headache. Paresthesia and muscle and joint pain started in temporal relation to a human papillomavirus (HPV) vaccination. Since the patient was suffering from severe pain, intensive pain management was performed. Skin and nerve biopsies revealed autoimmune small fiber neuropathy. The patient’s condition could be related to COVID-19, as her first symptoms began in temporal relation to the SARS-CoV-2 infection. Furthermore, in the disease course, antinuclear (ANA) and anti-Ro antibodies, as well as anti-cyclic citrullinated peptide (anti-CCP) antibodies, could be detected. Together with the symptoms of xerophthalmia and pharyngeal dryness, primary Sjögren’s syndrome was diagnosed. In conclusion, though biopsy results could not distinguish a cause of the disease, SARS-CoV-2 infection can be discussed as a likely trigger for the patient’s autoimmune reactions.

New-onset Immune-mediated Necrotizing Myopathy and Trigeminal Neuropathy after SARS-CoV-2 mRNA Vaccination in a Patient with Rheumatoid Arthritis and Sjögren's Syndrome

“…However, similar to the development of other autoimmune diseases, molecular mimicry and immune-mediated inflammatory reactions may also play a role ( 49 ). Although we did not find any specific reports of Sjögren's syndrome with trigeminal neuropathy after SARS-CoV-2 mRNA vaccination, we did find a case of peripheral neuropathy due to immune activation after SARS-CoV-2 infection in a patient with Sjögren's syndrome ( 50 ). Considering this finding, we cannot rule out the possibility that the vaccine-induced immune activation in the present case contributed to the manifestation of trigeminal neuropathy associated with Sjögren's syndrome.…”

Abnormal quantitative sudomotor axon reflex test results in patients with tinnitus as a possible indicator of small fiber neuropathy

“…The incidence of TN increases with the duration of DM, possibly as a result of increased neurosensory impairment, such as diabetic neuropathy ( 24 ). In addition, few case reports on SFN and TN in patients with COVID-19 have been documented ( 6 , 7 , 12 ).…”

Myocardial Oedema as a Consequence of Viral Infection and Persistence—A Narrative Review with Focus on COVID-19 and Post COVID Sequelae

“…SARS-CoV-2 infection of pericytes triggers in consequence viral entry into the central nervous system [ 534 ]. Moreover, viral persistence in the central and peripheral nervous system accounts for different post-COVID sequelae including symptoms of cognitive concerns and dysautonomia such as postural orthostatic tachycardia syndrome (POTS) and small fibre neuropathy [ 535 , 536 , 537 ]. In this context, it is hypothesized that microvascular dysfunction with interruption of pericyte integrity is one of the underlying major causes of post-COVID sequelae [ 538 ].…”