Disclosures: Benjamin Gill, DO, MBA: No financial relationships or conflicts of interest

Case Diagnosis: COVID-19 related pan-plexopathy

Case Description: A 32-year-old male presented with progressive hematochezia, fever, and dyspnea. Patient was diagnosed with anemia and COVID-19. Following gastral lumenoscopy, patient remained intubated with worsening pulmonary edema. Patient did not receive dexamethasone due to concern of gastrointestinal hemorrhage. Prone positioning, as is often used during intubation associated with COVID-19, nor other positions stretching the upper extremities were used. Patient was extubated three days later and immediately complained of right upper extremity weakness, painful paresthesias over the posterolateral forearm, and bilateral hand numbness.

Setting: Academic tertiary medical center and affiliated inpatient rehabilitation facilityAssessment/

Results: An electrodiagnostic study demonstrated an incomplete subacute right pan-plexopathy, preferentially affecting the upper trunk and lateral cord, with ongoing active denervation and no signs of re-innervation. In addition, there was evidence of a superimposed severe bilateral carpal tunnel syndrome with active denervation, which was suspected to be related to edema from recent transfusion of six units of blood products and exacerbation of remote history of carpal tunnel symptoms. The patient was provided bilateral wrist splints and scheduled for carpal tunnel releases. Gabapentin was prescribed in addition to modalities, including desensitization therapy, cryotherapy, massage, and passive range of motion.

Discussion: This is the first documented case of COVID-19 related plexopathy that is not associated with prone positioning. A previous single case of COVID-19 related plexopathy was thought to be due to tension from prone positioning, which did not occur in this case. Viral infection is hypothesized as the etiology of plexopathy in this case, potentially related to neuronal infiltration with subsequent inflammatory response or an ischemic process.

Conclusion: The COVID-19 pandemic continues to evolve. Additionally, we face the threat of future novel viruses. Continued research into the neurologic sequelae of patients afflicted with this infection will guide future treatments and rehabilitation.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/covid-19-related-plexopathy-without-prone-positioning-a-case-study/