New-onset chronic inflammatory demyelinating polyradiculoneuropathy after COVID-19 infection: a case report

October 2023

Abstract

Introduction and importance:

SARS-CoV-2 infection, besides respiratory symptoms, as cardinal manifestation, may present with neurological involvement. Immune-mediated polyradiculoneuropathy is one of the important neurological complications manifested by COVID-19 mainly includes Guillain–Barré syndrome (GBS), treatment-related fluctuation of GBS, and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Also, there are several reports of COVID-19 vaccine-related GBS and CIDP. According to possible severe manifestations of neuropathies like respiratory failure, considering these complications for early diagnosis and treatment is very important.

Case presentation:

The authors presented a 67-year-old woman with severe weakness in upper and lower extremities, the patient was diagnosed as case with CIDP initiated after COVID-19 virus infection and/or vaccination that experienced one relapse in 11 months. In both episodes, treatment with intravenous immunoglobulin started and the patient respond.

Clinical discussion:

To the best of our knowledge, this is one of the first reported cases with a typical chronic course of CIDP associated with COVID-19 virus infection and/or vaccination.

Conclusion:

Considering this complication and differentiation between GBS and CIDP, and then initiating maintenance therapy can prevent long-term disability.

What is CIDP?

Chronic inflammatory demyelinating polyneuropathy (CIDP) can be thought of as the chronic form of AIDP. It is primarily distinguished both by its time course—by definition, symptoms must persist for at least 8weeks—and its responsiveness to corticosteroid treatment (AIDP, you may recall, is not steroid responsive). It tends to be monophasic, with a relatively gradual onset and even more gradual recovery, but some patients can present with a relapsing and remitting course. Otherwise, CIDP closely resembles AIDP, with predominantly distal, symmetric, ascending motor weakness and decreased or absent reflexes. Albuminocytologic dissociation in the CSF is a hallmark finding, as with AIDP. IVIG, PLEX, or pulse high- dose corticosteroids are first- line treatment.

There are several CIDP variants, including sensory- predominant and pure motor forms, that can be harder to recognize and diagnose. CSF analysis and electrophysiologic testing are helpful.