SHM Converge Scientific Abstract ePoster Gallery-Dystonia - A Rare Post-Infectious Covid 19 Disease Manifestation

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This case report describes a rare post-infectious movement disorder following mild COVID-19 infection. A 60-year-old woman with ulcerative colitis and hypertension developed progressive involuntary, jerky, spasmodic movements about three weeks after testing positive for COVID-19. Her symptoms included clumsiness, dropping objects, abnormal speech with spasmodic voice changes, difficulty eating, intermittent confusion, and later involuntary contractions of the legs that impaired walking. On exam, her movements were most consistent with dystonia, though they sometimes resembled chorea or ballism. During hospitalization, she also developed a partial left abducens nerve palsy.<br /><br />Extensive workup was unrevealing. Routine labs, autoimmune testing, brain MRI, MRA, EEG, and lumbar puncture studies were normal or negative, including infectious, autoimmune, movement disorder, and paraneoplastic panels. Amantadine did not improve her symptoms. Given concern for a postinfectious autoimmune process related to COVID-19, she was treated with intravenous immunoglobulin (IVIG) and high-dose methylprednisolone for five days. She experienced partial improvement and was discharged to rehabilitation after a 10-day hospitalization.<br /><br />The authors note that neurologic movement disorders can occur after COVID-19, even after mild cases. Myoclonus is reported most commonly, followed by ataxia, oculomotor dysfunction, polyneuropathy, and encephalopathy. Dystonia is much rarer but can be severely disabling. Proposed mechanisms include direct brainstem invasion via ACE2 receptors, hypoxia, inflammatory cytokines, and autoimmune responses. The case suggests that IVIG and steroids may be beneficial in suspected post- or para-infectious COVID-related dystonia.

Asset Subtitle

Danial A. Khan

Meta Tag

Author List Ameen Al Matrood, Danial A. Khan, Deepak Vedamurthy, Jason Silversteen, Kimberly P. Gannon

Category Clinical Vignettes

Concept COVID-19

Concept Dystonia

Concept Post-infectious neurologic movement disorder

Concept Post-infectious autoimmune dystonia

Concept Chorea

Distinguished Non-Finalist

Presenter Organization Christiana Care Health System

Presenting Author Danial A. Khan

Track Adult

Keywords

COVID-19

dystonia

post-infectious

movement disorder

myoclonus

IVIG

methylprednisolone

autoimmune

chorea

abducens palsy

COVID-19

Dystonia

Post-infectious neurologic movement disorder

Post-infectious autoimmune dystonia

Chorea