Disclosures: Gurpreet Sarwan, DO: No financial relationships or conflicts of interest

Case Diagnosis: This case discusses the rehabilitation of a patient with multiple sclerosis exacerbation, complicated by COVID-19 infection.

Case Description: A 66-year-old female patient with a past medical history of multiple sclerosis (MS) presented to the emergency room complaining of urinary incontinence. The patient denied any other symptoms at that time. In the ED, the patient was found to have a temperature of 101.9 degrees Fahrenheit. Urinalysis was found negative. The patient was found positive for COVID-19 infection.

Setting: Tertiary-care teaching hospitalAssessment/

Results: The patient was found positive for COVID via PCR testing. Initial chest x-ray on ED presentation was negative, however, repeat five days later was suspicious for atypical pneumonia. The patient was given 1 unit of convalescent plasma and completed a course of Remdesivir. Due to her acute weakness in bilateral lower extremities and new onset of sensory deficits in bilateral lower extremities, the patient was also tested for Guillain-Barre syndrome, but found negative on lumbar puncture.

Discussion: Management of MS exacerbations can be difficult, due to varying presentation. This patient had a history of urinary symptoms with prior MS exacerbations, however, this time the symptoms presented more aggressively. During the hospital course, the patient had increased weakness and sensory deficits in bilateral lower extremities. The patient was independent with her activities of daily living (ADLs), however this time she required moderate assistance with bed mobility, transfers, and ambulation on initial evaluation.

Conclusion: Multiple sclerosis can have detrimental effects on patients, severely impacting a patient’s ability to perform ADLs. This case highlights the impact COVID-19 infection can have on an MS exacerbation. The patient initially required moderate assistance with bed mobility, transfers, and ambulation with an assistive device, but improved to minimum assistance on discharge to subacute rehabilitation.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/multiple-sclerosis-exacerbation-complicated-by-covid-19-infection-a-case-report/