Disclosures: Susan B. Liu, DO: No financial relationships or conflicts of interest

Case Diagnosis: 75 year old male with a presumed resolved COVID infection who developed Acute Inflammatory Demyelinating Polyneuropathy (AIDP) weeks after an initial dose of the Pfizer vaccine (PV)

Case Description: The patient had a COVID-19 infection that did not require hospitalization, presumed resolved, and received an initial dose of the PV three weeks later. He presented to the Emergency Department (ED) three weeks after his initial dose with bilateral symmetrical weakness of all extremities, distal limb paresthesias, and impaired proprioception in his toes, and discharged home. Two days later, he presented to the ED for worsening symptoms and gait instability, tested positive for COVID-19, and was admitted to Neurology for AIDP in the setting of persistent COVID-19 infection as opposed to a response to the vaccine itself. Due to recent anticoagulation use, lumbar puncture was deferred and he was treated with five days of empiric intravenous immunoglobulin (IVIG). Electrodiagnostic studies showed sensorimotor polyneuropathy with axonal and demyelinating features thought to be early signs of AIDP. He developed hyponatremia that spontaneously resolved. Patient was admitted to AIR at moderate assistance level with an assistive device.

Setting: Acute inpatient rehabilitation (AIR)Assessment/

Results: This patient developed AIDP three weeks following PV administration after having a presumed resolved COVID-19 infection, but still tested positive on admission. Symptoms improved with IVIG and therapy focused on impaired sensation, endurance, strength, and balance. This patient was discharged home from AIR at an independent level.

Discussion: AIDP is an uncommon complication of COVID-19. Treatment typically includes IVIG along with a potential rehabilitation course as guided by a physiatrist. It is imperative for physiatrists to diagnose AIDP as a complication of COVID-19 exacerbated by PV administration.

Conclusion: AIDP is a potential complication of COVID-19 infection exacerbated by PV administration and may require acute inpatient rehabilitation to address patients’ resulting functional deficits.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/acute-inflammatory-demyelinating-polyneuropathy-following-first-covid-vaccine-dose-with-prolonged-covid-19-infection/