(Kiosk 5) Recurrent Chemo-related Peripheral Polyneuropathy After COVID-19 Infection - A Case Report

Case Diagnosis: Recurrent chemotherapy-induced peripheral neuropathy after coronavirus-disease-2019 (COVID-19) infection.

Case Description or Program Description: 59-year-old male with an oncologic history of rectal adenocarcinoma, treated by chemotherapy (capecitabine, oxaliplatin, and 5-fluorouracil), radiation therapy and abdominal perineal resection presented to the pain clinic for recurrent chemotherapy-induced peripheral neuropathy (rCIPN) after COVID-19. Prior to infection, he experienced burning pain and dysesthesias in a stocking-glove distribution following chemotherapy, but over time his symptoms improved, such that he successfully weaned off of gabapentin. Several months later, he was diagnosed with COVID-19, and within one week of infection, he experienced return of peripheral neuropathic pain.

Setting: Outpatient Pain Clinic

Assessment/Results: The patient was restarted on gabapentin for rCIPN; however, despite dose escalation, there was no relief in pain and the side effect profile was too burdensome. He was then started on pregabalin and reported near-resolution of the neuropathic pain from rCIPN.

Discussion (relevance): Recent studies have shown that COVID-19 can lead to neurological manifestations in the central nervous system, such as encephalopathy, encephalitis, stroke, etc., and the peripheral nervous system including new-onset anosmia/ageusia, peripheral neuropathy, new/recurrent Guillain-Barre Syndrome (GBS). The mechanisms behind these neurological complications are linked to the virus-induced hyperinflammatory and hypercoagulable states, direct virus infection of the nervous system, and postinfectious immune-mediated processes. Our case report seems to be one of the first cases, to our knowledge, showing COVID-19 infection as a possible trigger for rCIPN. The closest studies of COVID-19 causing recurrent peripheral neuropathy are cases involving recurrent GBS (rGBS) post-COVID-19 infection. Although our patient's neurological symptoms were more similar to previous CIPN, the mechanism of rCIPN might be similar to that of COVID-19-induced rGBS, which is immune-mediated.

Conclusions: Management of rCIPN in cancer patients can be challenging. This case report highlights rCIPN in the setting of a COVID-19 infection and emphasizes the need for research into this phenomenon.