(Kiosk 4) Prolonged Rehabilitation from COVID-19 Due to Multiple Neurologic Hits : A Case Report

Case Diagnosis: Critical illness myopathy (CIM) and polyneuropathy (CIP) with superimposed compressive neuropathies related to Coronavirus Disease 19 (COVID-19).

Case Description or Program Description: A 38-year-old male with morbid obesity, asthma, and alcohol abuse suffered severe COVID-19 pneumonia, requiring a prolonged intensive care unit (ICU) stay, mechanical ventilation, and proning. After stabilizing two months later, he was profoundly weak with sensory alterations concerning for CIM, CIP, and compressive mononeuropathies. He required maximal assistance for activities of daily living and an assistive device for ambulation. During six weeks of inpatient rehabilitation, his function improved but was slowed by ongoing weak left hand grip, left foot drop, and gait difficulties. Symptoms persisted, and four months later, electromyography (EMG) of the left upper limb revealed injury of the musculocutaneous, suprascapular, axillary and ulnar nerves. Left lower limb EMG revealed polyneuropathy and peroneal neuropathy. The patient continued outpatient therapies and was prescribed a custom ankle foot orthosis.

Setting: Urban Level-1 Trauma Center

Assessment/Results: Functional recovery from severe COVID-19 is significantly impacted by the development of CIM, CIP, and multiple compressive mononeuropathies.

Discussion (relevance): Up to 50% of patients can develop CIM/CIP related to severe COVID-19 infection. CIM denotes sensory preservation and proximal weakness while CIP indicates sensory changes and distal weakness. Early diagnosis and mobilization in CIM/CIP are associated with improved functional outcomes. Additional neurologic sequelae from COVID-19 include peripheral nerve injuries, occuring in 8.9% of patients, and are associated with prolonged hospitalization, prone positioning, inflammatory neuropathies, and trauma-associated nerve entrapment. Associated comorbidities include substance abuse, prior peripheral neuropathy, and thin or obese body habitus. Treatment of CIM, CIP, and peripheral nerve injuries (most commonly the brachial plexus and ulnar nerve) must address the underlying cause and support functional recovery.

Conclusions: This case illustrates the debilitating effects of CIM/CIP in the setting of COVID-19 and the severe impact of superimposed neuropathies on rehabilitation and recovery timeline.