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Abstract Details

A Case of Steroid Responsive Parkinsonism Para-COVID-19 Infection: Immune-Mediated or Unmasking Neurodegeneration?
Autoimmune Neurology
P3 - Poster Session 3 (12:00 PM-1:00 PM)
062
To report a case of para-infectious parkinsonism that was initially steroid responsive, suggesting an immune-mediated process.
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.
N/A
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.
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, FÂ鶹´«Ã½Ó³»­ 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, FÂ鶹´«Ã½Ó³»­ Dr. Samkoff has nothing to disclose.