Abstract Details

Title A Case of Steroid Responsive Parkinsonism Para-COVID-19 Infection: Immune-Mediated or Unmasking Neurodegeneration?

Topic Autoimmune Neurology

Presentation(s) P3 - Poster Session 3 (12:00 PM-1:00 PM)

Poster/Presentation
Number 062

Objective To report a case of para-infectious parkinsonism that was initially steroid responsive, suggesting an immune-mediated process.

Background Para-infectious parkinsonism has been well described for over a century, most notably during the encephalitis lethargica epidemic. Parkinsonism has been associated with members of the Herpesviridae, Orthomyxoviridae, Flaviviridae, Retroviridae, Paroxymoviridae, and Picornaviridae families. Increasing cases of parkinsonism following COVID-19 infections are being reported. Herein, we present a case of steroid responsive para-infectious parkinsonism.

Design/Methods N/A

Results A 50-year-old male with a history of hypertension developed new onset dexterity loss in left arm over the course of 24-48 hours in the setting of COVID-19 infection. Neurologic examination was notable for moderate left sided bradykinesia and rigidity, left thumb rest tremor, and reduced left arm swing. History is negative for longstanding anosmia, constipation, or dream-reenactment behavior. MRI brain demonstrated T2 hyperintense lesion in the right anterior insula. Spinal fluid analysis had mildly elevated protein (59 mg/dL), but it otherwise lacked nucleated cells and oligoclonal bands. 14-3-3 and movement disorders auto-antibodies panels were negative. Dopamine Transporter (DaT) scan had decreased uptake in bilateral basal ganglia, more markedly on the right. Positron emission tomography (PET) scan was negative for malignancy except a fluorodeoxyglucose-avid left cervical lymph node of uncertain significance. Due to concern for a parainfectious, immune-mediated process, prednisone (60 mg for 3 days with taper) was administered with marked improvement in parkinsonism. However, parkinsonism worsened after steroid wean, and repeat prednisone course was ineffective. He was subsequently treated with carbidopa/levodopa and rasagiline with improvement. He is pending trial of intravenous immunoglobulin.

Conclusions This case demonstrates para-infectious parkinsonism that was initially responsive to corticosteroid use. However, steroid responsiveness was not sustained. This clinical course could signify an initially immune-mediated inflammatory injury with subsequent neurodegeneration.

Authors/Disclosures
Jordan Carrier, MD (Corewell Health) PRESENTER	Dr. CARRIER has nothing to disclose.
Cheng Chin Wang, DO	Dr. Wang has nothing to disclose.
Irene Richard, MD, FAAN	Dr. Richard has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Katten Muchin Rosenman Law Firm. The institution of Dr. Richard has received research support from Michael J Fox Foundation for Parkinson's Research.
Lawrence M. Samkoff, MD, FAAN (University of Rochester School of Medicine and Dentistry)	Dr. Samkoff has nothing to disclose.

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