To report the clinical course and outcome of two patients with known diagnosis of Amyotrophic Lateral Sclerosis (ALS) who developed COVID-19 infection.

It is hypothesized that respiratory muscle weakness as seen in ALS may result in worse outcome related to COVID-19 infection. There are no reported cases of clinical course and outcome in ALS patients.

Electronic medical records of patients with ALS who developed COVID-19 were reviewed.

The first patient was a 42-year-old African American male with diagnosis of ALS for over 2 years and the second patient was a 74-year-old Caucasian female with ALS for 1 year. Both the patients had respiratory weakness requiring continuous positive airway pressure (CPAP) support prior to admission. They were admitted with increasing breathing difficulty and were diagnosed as multifocal pneumonia. COVID-19 testing for patient 1 was negative twice, however, given his Chest X-ray findings and increased acute phase reactants, Infectious Disease specialist strongly suspected coronavirus infection. His respiratory support was escalated to BiPAP support along with antibiotics - Vancomycin and Zosyn. After stay in the Intensive Care Unit for 4 days, he was weaned down to his baseline CPAP support and discharged home with home hospice for ALS. Patient 2 had increasing oxygen requirement necessitating admission to the hospital. She was positive for COVID-19 infection and was treated with Remdisivir and solumedrol. She improved to her baseline status and was discharged home in a stable condition. Neither patient developed any other organ system dysfunction.

Our two patients with ALS, one with confirmed and the other with suspected COVID-19 infection, recovered back to their baseline respiratory status, despite their baseline dependence on CPAP for neuromuscular respiratory weakness. There are no case reports of concomitant ALS and COVID-19 infection.