2023 American Academy of Neurology Abstract Website

Objective:

To determine the frequency of skin denervation in patients with SFN-related symptoms following Covid19 vaccination or infection.

Background:

Small fiber neuropathy (SFN) is associated with sensory and autonomic symptoms as well as fatigue, and is evident by skin biopsy which shows a reduction of the intra-epidermal nerve fiber density (IENFD) indicating skin denervation. These SFN-related symptoms are commonly reported following Covid19 vaccination and infection, and SFN was reported following both conditions. However, it is not clear if skin denervation is common in patients reporting these symptoms after Covid19 vaccination or infection.

Design/Methods:

A cross-sectional chart-review analysis of patients who were referred for a skin biopsy due to SFN-related symptoms during 2021. Patients were included if symptoms began within 1-60 days following Covid19 vaccination or infection.

Results:

We identified 22 patients, of which 17 (14 females, mean age 51, range 33-83) reported symptoms following vaccination. These occurred in 10 patients after the 1st, in 5 after the 2nd and in 2 after the 3rd dose, respectively. Symptoms following infection were reported by 5 patients (3 females, mean age 45, range 25-59). The mean time to symptoms onset following vaccination or infection was 9 and 27 days, respectively. All patients reported pain and sensory symptoms. Autonomic symptoms were reported by 8/17 (47%) following vaccination and by 3/5 patients (60%) following infection. Fatigue was reported by 11/17 patients (64%) following vaccination and by all patients following infection. Skin denervation was evident in 13/22 (59%) of patients; in 11/17 patients (64%) following vaccination and 2/5 patients (40%) following infection. Fisher’s exact test showed no correlation between skin denervation and autonomic symptoms (p=0.629) or fatigue (p=0.41).

Conclusions:

This small cohort showed that skin denervation occurs in about half of the patients with SFN-related symptoms following Covid19 vaccination or infection.