(Kiosk 3) Acute COVID-19 Infection as Etiology for Exacerbation of Parsonage-turner Syndrome (Neuralgic Amyotrophy): A Case Report

Case Diagnosis: 43-year-old woman with Neuralgic Amyotrophy (NA)

Case Description or Program Description: Patient was referred due to concern of right upper extremity (RUE) adhesive capsulitis after ICU stay. On presentation, she reported resolved RUE pain but persistent patchy RUE numbness and proximal RUE weakness. Exam revealed medial winging of the scapula and inability to flex or abduct the shoulder beyond 90 degrees. Her RUE strength was otherwise full or nearly full throughout. She was counseled on the leading diagnosis of NA, prescribed physical therapy, and was referred for EMG/NCS to investigate NA versus cervical radiculopathy.

Setting: PM&R Clinic

Assessment/Results: EMG demonstrated fibrillation potentials in the infraspinatus, serratus anterior, pronator teres, triceps, and flexor carpi radialis (FCR) on the RUE. There were no volitional motor unit action potentials in the triceps or serratus anterior. There was also markedly reduced discrete pattern of motor recruitment in the right infraspinatus and right FCR. NCS were noted to be essentially normal. These findings were supportive of the diagnosis of NA, and she began an extended course of physical therapy. At 4 months from presentation, she had near resolution of her symptoms and was able to return to work full time. However, two months later she was diagnosed with acute COVID-19 infection and suffered a recrudescence of RUE burning pain and shoulder weakness similar to her initial presentation. She was subsequently initiated on gabapentin for neuropathic pain and prescribed a second course of physical therapy. Over time, her symptoms again resolved and she returned to her baseline.

Discussion (relevance): While little is known about etiologies of NA, there is less data on the effect of inflammatory insults longitudinally throughout the disease course. This report details a case where acute COVID-19 infection appears to have exacerbated the disease course of a patient with known NA.

Conclusions: Systemic inflammation secondary to acute COVID-19 infection appears to be a risk factor for exacerbation or recurrence of known NA.