Curious case of steroid responsive diffuse anterior horn cell disease associated with COVID-19 infection

Abstract

Covid-19-associated neurological manifestations are being reported with increased frequency throughout the world. In a study from China, symptoms referable to peripheral nervous system (PNS) were described in approximately 9% of hospitalized Covid-19 patients. Common PNS symptoms reported in the study were loss of taste/smell and muscle pains. With this communication, we expand the spectrum of PNS manifestations of Covid-19 infection by reporting an association of steroid responsive diffuse anterior horn cell disease with Covid-19 infection from a tertiary care centre in India. Neurological manifestations of Covid-19 are diverse, and our case which to best of my knowledge is the first case in literature to report an occurrence of steroid responsive diffuse anterior horn cell disease associated with Covid-19 infection, adds to the ever-increasing spectrum of neurological manifestations associated with this pandemic causing virus. Good response to steroid in our case serves to provide an insight into the possible pathogenesis of this manifestation and also paves the way for future therapeutic decisions related to this association.

COVID-19 and post-poliomyelitis syndrome: coincidence?

“…To the best of our knowledge, this is the first case report of PPS related to COVID-19. A case report of a 23-year-old female patient with COVID-19 described steroid-responsive diffuse anterior horn cell disease 12 . Taking into account these two patients and the relation of PPS and COVID-19 with the inflammatory system, we thought that para-infectious dysregulation of the immune system caused by COVID-19 might trigger the decompensatory basis of PPS.…”

Prevalence, pathogenesis and spectrum of neurological symptoms in COVID‐19 and post‐COVID‐19 syndrome: a narrative review

“…The first category has included events such as brachial plexiitis 28 and steroid responsive diffuse anterior horn cell disease. 29 These disorders are likely to relate to a systemic inflammatory response in the setting of COVID-19, and their treatment is likely to include immunotherapy such as corticosteroids.…”

“…Peripheral nervous system involvement in COVID‐19 (excluding GBS, which will be discussed separately) appears to fall into two main categories: i) rare inflammatory events that have been reported in case reports or case series; and ii) critical illness neuropathy or myopathy due to prolonged severe pulmonary illness. The first category has included events such as brachial plexiitis 28 and steroid responsive diffuse anterior horn cell disease 29 . These disorders are likely to relate to a systemic inflammatory response in the setting of COVID‐19, and their treatment is likely to include immunotherapy such as corticosteroids.…”