Case Diagnosis: 27-year-old healthy female with 5 days of progressive bilateral lower extremity weakness in setting of COVID-19 illness.

Case Description: Initially diagnosed with Covid-19 two weeks prior, the patient presented to the Emergency Department with a five-day history of acute onset symmetric weakness beginning from her proximal hips, which progressively extended distally to her feet. Physical exam on day 5 of admission revealed asymmetric lower extremity weakness, left greater than right and proximal greater than distal. Sensation was decreased to light touch on the bilateral thighs. Reflexes were 2+ throughout. Laboratory and imaging workup included complete blood work, cervical MRI, thoracic and lumbar plain-films and a lumbar puncture, which were grossly unrevealing. Physiatry was consulted for electromyography (EMG) to further investigate. The next day, the physical exam was unchanged, but now revealed absence of distal reflexes. EMG revealed normal distal motor latencies, amplitudes and conduction velocities, but absent bilateral peroneal F waves and tibial H reflexes with sural sparing.

Setting: Acute Care Community HospitalAssessment/

Results: Results of EMG indicate diagnosis of AIDP, the most common variant of Guillain-Barré syndrome (GBS). The patient received five days of intravenous immunoglobulin (IVIG) and experienced a rapid motor recovery. On the sixth day after initiation of treatment, the patient was able to ambulate sixty feet with assistance and discharged to acute rehab with a good prognosis for functional recovery.

Discussion: There has been an increased incidence of GBS secondary to Covid-19. This patient had an atypical presentation of GBS with a normal lumbar puncture, and motor loss that travelled from proximal to distal. It is prudent that clinicians are aware of potential atypical presentations and the advantages of early EMG in the acute care setting for diagnosis and early intervention.

Conclusion: EMG plays a critical role in the acute hospital setting for early diagnosis and management of Covid-related AIDP.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-atypical-presentation-of-acute-inflammatory-demyelinating-polyneuropathy-following-covid-19-infection/