Disclosures: Christopher Yih, DO: No financial relationships or conflicts of interest

Case Diagnosis: Unilateral post-COVID-19 ptosis

Case Description or Program Description: A 50-year-old man recovering from a severe SARS-CoV-2 infection requiring remdesivir, convalescent plasma, clazakizumab, intubation, and extracorporeal membrane oxygenation (ECMO) in the ICU was admitted to Inpatient Rehab on supplemental oxygen via nasal cannula, a prednisone taper, and an intact neurologic exam. He was noted to have right sided ptosis and anisocoria without other novel focal neurologic deficits or physical exam findings on IRF day 9. The only medication change was a taper of his oral prednisone from 10mg to 5mg four days prior. Prednisone was decreased to 4mg daily on IRF day 12, with mild improvement of patient’s symptoms noted on IRF day 15. He was discharged prolonged steroid taper due to adrenal insufficiency and continued to have ptosis of his right eyelid and anisocoria. 4 weeks after onset of ptosis and anisocoria, he continued to demonstrate these oculomotor nerve symptoms worsened with fatigue and improved with rest.

Setting: Acute Inpatient Rehabilitation

Assessment/Results: persistent Covid-19 induced unilateral ptosis

Discussion (relevance): Nerve palsies following COVID-19 infections have been sporadically reported, however an isolated unilateral oculomotor nerve palsy has been seldom referenced. This patient’s symptoms emerged following a decrease in his steroid taper.

Conclusions: Unilateral post-viral ptosis may be another condition added to the long list of post SARS-CoV-2 sequelae.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/unilateral-oculomotor-nerve-palsy-post-covid-19-infection-in-the-setting-of-a-steroid-taper-a-case-report/