Bilateral paralysis of peroneal nerve after COVID-19 disease: a case report

Abstract

Background COVID-19, caused by a novel coronavirus SARS-CoV 2 has rapidly developed into pandemic. This infectious disease affecting mainly respiratory system may cause multiple systemic disorders. With increasing number of new infected patients there are more and more cases with neurological complications secondary to COVID-19. Case presentation Here we present a case of 67-years old Polish male with previously no comorbidities, who has developed bilateral paralysis of peroneal nerve after SARS-CoV 2 infection. Prior to the hospitalization he presented cough and fever and weakness. RT-PCR was reported positive for COVID-19 infection. Then he developed pneumonia and respiratory failure with bilateral lung consolidations on radiological examination. Laboratory findings revealed elevated levels of D-dimer, CRP, AspAT, GGTP, PCT and serum glucose. After discharge from hospital he was diagnosed with thrombophlebitis and prediabetes on follow-up visits. Due to problems with walking, numbness of toes and involuntary muscle spasms in hands, the patient went to the Neurological Outpatient Clinic. After neurological examination bilateral paralysis of peroneal nerve was revealed. Conclusions In this report we want to highlight one of the unexpected presentations of SARS-CoV 2 infection and emphasize the importance of neurological examination in COVID-19 patients.

Post-COVID-19 Neurological Sequelae of Polyneuropathy and Encephalitis: A Comprehensive Case Report

“…The patient did not present with ascending limb weakness, which makes GBS less likely. One case report described the involvement of the bilateral peroneal nerve, which presented with zero ankle reflexes and foot drop bilaterally [7]. Critical illness polyneuropathy and myopathy were also considered part of the differentials for the patient; however, the muscle weakness was not symmetrical, and there were no sensory deficits noted [8].…”

Neuromuscular Disorders Associated With COVID-19

“…Phrenic nerve paralysis has also been reported. 28 This should be suspected especially if there is a pronounced difficulty in weaning from a respirator or if there are other neurologic manifestations.…”

“…Additionally, reports of bilateral peroneal nerve paralysis 28 and Parsonage-Turner Syndrome (brachial plexus-based neuritis) in individuals recovering or recovered from COVID-19 implicate the virus in these peripheral nerve disorders. 29,30 This is further confounded by known brachial plexopathies following prone positioning, commonly utilized in severe COVID-19 respiratory infections, though these tend to occur without pain, separating them from a typical neuritis.…”