Disclosures: Jonathan L. Liang, DO: No financial relationships or conflicts of interest

Case Diagnosis: A 35-year-old male with history of alcohol abuse.

Case Description: The patient presented to the emergency department with two weeks of rapidly progressive lower extremity weakness ascending to the upper extremities with an associated burning sensation of the fingertips bilaterally. Physical exam revealed predominantly distal over proximal, symmetric arm weakness and diffusely symmetric lower extremity weakness, with hyporeflexia in upper extremities and areflexia in lower extremities. Nerve conduction studies revealed decreased compound motor action potential (CMAP) amplitudes in the fibular, tibial, and radial nerves with normal distal latencies. Sensory nerve action potential (SNAP) amplitudes were normal. Electromyography revealed fibrillation potentials in the upper and lower extremities. The findings were consistent with acute axonal motor predominant polyradiculoneuropathy with sural sparing. SARS-CoV-2 polymerase chain testing was positive. Thiamine and vitamin E levels were low. Cerebrospinal fluid analysis did not reveal albuminocytologic dissociation, nor other source of infection. He received intravenous immunoglobulin (IVIg) for five days, intravenous thiamine and vitamin E, and convalescent plasma for COVID-19 with rapid improvement of strength. He was then discharged.

Setting: Academic teaching hospital and clinicAssessment/

Results: He was seen in clinic five weeks later and was noted with further improvement of overall strength. Repeat electrodiagnostic testing demonstrated a motor-predominant axonal polyradiculoneuropathy with overall improvement in CMAPs and less active denervation on needle examination.

Discussion: This case adds to the rare incidence of acute motor axonal neuropathy (AMAN), a variant of Guillain Barre Syndrome (GBS), secondary to COVID-19. It also presents a diagnostic question of how to differentiate acute weakness as being due to an immune mediated process, such as from COVID-19, versus a nutritional polyneuropathy, such as from alcoholic thiamine deficiency.

Conclusion: We argue that the electrodiagnostic and clinical evidence of finger-extension weakness (“finger drop sign”), as well as the electrodiagnostic evidence of sural sparing, favors the diagnosis of GBS, specifically AMAN.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2021

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/acute-motor-axonal-neuropathy-secondary-to-covid-19-versus-alcoholic-thiamine-deficiency-a-case-report/