208 - That’s A Long One: A case of multisystemic symptoms secondary to long COVID which was initially misdiagnosed as transverse myelitis; A Case Report

Case Diagnosis: Gait and activities of daily living dysfunction secondary to long COVID.

Case Description:
A 55-year-old male with a past medical history of COVID-19 and polyneuropathy presents to the spinal cord injury clinic with chief complaints of lower extremity spasms, generalized weakness, fatigue, weight loss, and functional decline. In 2020 the patient contracted COVID-19 and a few weeks later he started experiencing the aforementioned symptoms. He was evaluated by a neurologist who prescribed him a low dose steroid that he took from 2020 to 2022 which effectively alleviated his symptoms. He also saw another neurologist who did a full work up, which included an MRI (magnetic resonance imaging) brain, cervical spine, thoracic spine, CT (computerized tomography) chest, abdomen/pelvis, LP (lumbar puncture), EMG/NCS (electromyography/nerve conduction study), autoimmune panel, viral panel, and oncological work up.

Discussions:
The workup, which included imaging, labs, and studies were all negative for any significant pathologies. As a result, the patient was diagnosed with transverse myelitis. Since there were no T2 hyperintense signal changes on spinal MRI or the absence of upper motor neuron signs on physical exam, this is likely not a diagnosis of transverse myelitis. A patient with generalized weakness, fatigue, weight loss, functional decline, negative imaging, negative labs, and negative studies will likely have the diagnosis of long COVID.

Conclusions: Long COVID is a diagnosis of exclusion that must be thoroughly evaluated through a patient’s detailed history and physical exam. Although extremely rare, clinicians should be aware of long COVID as a potential diagnosis. Once diagnosed, physiatrists can work with the patient to improve overall function and quality of life.