COVID-19 atypical Parsonage-Turner syndrome: a case report

Abstract

Background Neurological manifestations of Sars-CoV-2 infection have been described since March 2020 and include both central and peripheral nervous system manifestations. Neurological symptoms, such as headache or persistent loss of smell and taste, have also been documented in COVID-19 long-haulers. Moreover, long lasting fatigue, mild cognitive impairment and sleep disorders appear to be frequent long term neurological manifestations after hospitalization due to COVID-19. Less is known in relation to peripheral nerve injury related to Sars-CoV-2 infection. Case presentation We report the case of a 47-year-old female presenting with a unilateral chest pain radiating to the left arm lasting for more than two months after recovery from Sars-CoV-2 infection. After referral to our post-acute outpatient service for COVID-19 long haulers, she was diagnosed with a unilateral, atypical, pure sensory brachial plexus neuritis potentially related to COVID-19, which occurred during the acute phase of a mild Sars-CoV-2 infection and persisted for months after resolution of the infection. Conclusions We presented a case of atypical Parsonage-Turner syndrome potentially triggered by Sars-CoV-2 infection, with symptoms and repercussion lasting after viral clearance. A direct involvement of the virus remains uncertain, and the physiopathology is unclear. The treatment of COVID-19 and its long-term consequences represents a relatively new challenge for clinicians and health care providers. A multidisciplinary approach to following-up COVID-19 survivors is strongly advised.

Parsonage-Turner Syndrome Following SARS-CoV-2 Infection: A Systematic Review

“…After deduplication, 288 articles were included. Finally, we identified 57 papers on PTS in patients with COVID-19 to assess in full text; 21 papers were ultimately included [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. The screening and selection of papers were conducted by one reviewer and cross-checked by a second author.…”

“…This systematic review included 21 articles reporting on 26 cases of patients from the USA (8 cases) [ 25 , 27 , 32 , 38 , 40 , 44 ], France (6 patients) [ 34 , 36 , 41 , 43 ], Italy (3 cases) [ 29 , 31 , 45 ], Spain (1 case) [ 26 ], Germany (1 case) [ 42 ], Hong Kong (1 case) [ 33 ], Singapore [ 39 ], Kuwait (1 case) [ 37 ], Iran (1 case) [ 28 ], Chile [ 35 ], and Mexico (2 cases) [ 30 ].…”

“…In two patients (2/26, 7.7%), the onset time of PTS was unclear [ 26 , 29 ]. The neurological complaints were reported to occur simultaneously with COVID-19 in 5/24 (20.8%) patients [ 30 , 32 , 41 , 45 ], and within one week of infection in 3/24 (12.5%) cases [ 25 , 37 , 39 ]. Nine individuals (9/24, 37.5%) developed PTS after more than seven days but within one month of infection [ 28 , 31 , 32 , 33 , 35 , 36 , 42 , 43 ].…”

“…A motor deficit was present in 21/26 (80.8%) patients [ 26 , 27 , 28 , 29 , 32 , 33 , 34 , 35 , 36 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 46 ]. Muscle strength was normal in 3/26 (11.5%) patients; two presented a pure sensory PTS [ 31 , 45 ], and one case is unclear: the authors report a normal motor function, but eight weeks later, he had scapula winging [ 25 ]. In addition, in two familial cases (2/26), the authors do not mention any motor deficit, but the patients presented deltoid, supraspinatus, and scapular muscle wasting [ 30 ].…”

“…Paresthesia was noted in 12/26 (46.2%) PTS individuals [ 25 , 26 , 27 , 30 , 32 , 33 , 37 , 39 , 40 , 42 ]. However, a sensory loss was reported in 9/26 (34.6%) patients [ 26 , 28 , 31 , 33 , 37 , 42 , 43 , 44 , 45 ].…”