Acute Motor and Sensory Axonal Neuropathy (AMSAN) Relapse After COVID-19 Infection: A Case Report and Literature Review
Fritz Vascones Roman1, Karlos Acurio2, Niels Pacheco3, Varun Jain4, Miguel Chuquilin Arista4
1Cayetano Heredia Peruvian University, 2Universidad Peruana Cayetano Heredia, 3Harvard Medical School, 4University of Florida
Objective:
To describe a case of acute motor and sensory axonal neuropathy (AMSAN), a rare variant of Guillain-Barré syndrome (GBS), in the setting of preceding COVID-19 infection and discuss reported cases of this condition up to date.
Background:
Only few cases of the AMSAN variant of GBS in the setting of COVID-19 have been reported. To our knowledge, this is the first case of a relapse of the condition following a COVID- 19 infection.
A case report and review of literature on PubMed was performed and summarized.
Design/Methods:
A 58-year-old male presented with worsening weakness. He had severely reduced strength in all limbs, numbness and areflexia. CSF showed increased protein and pleocytosis with lymphocytic predominance. Lumbar MRI showed cauda equina root enhancement, and the EMG revealed severe sensorimotor axonal polyneuropathy, with no demyelinating findings, consistent with AMSAN. High dose intravenous methylprednisolone (IVMP) was started, and the patient was discharged with partial improvement. Five months later, he had his 2nd COVID-19 infection that was followed by progressive weakness and numbness and prompted readmission. MRI showed persistence of cauda equina root enhancement. The patient was diagnosed with AMSAN relapse and was started on IV methylprednisolone and IVIG with mild recovery.
Results:
37 cases of AMSAN in the setting of COVID-19 were identified. Patients presented with AMSAN symptoms 1-100 days after COVID-19 infection. CSF was characterized by elevated protein. Anti-ganglioside antibodies were found only on 2 patients. Most patients recovered partially after IVIG treatment although 5 of them died during the follow up. Our case was the only one that presented symptom relapse after a 2nd COVID-19 infection.
Conclusions:
The development of worsening weakness after a COVID-19 infection and axonal findings of EMG should alert the clinician about the possibility of AMSAN or GBS variants. Relapse of symptoms should be considered.