Case-control study of individuals with small fiber neuropathy after COVID-19

View Publication on PubMed

Published

May 2024

Journal

Neurology Neuroimmunology & Neuroinflammation

Abstract

Objectives: To report a case-control study of new-onset small fiber neuropathy (SFN) after COVID-19 with invasive cardiopulmonary exercise testing (iCPET). SFN is a critical objective finding in long COVID and amenable to treatment. Methods: A retrospective chart review was conducted on patients seen in the NeuroCOVID Clinic at Yale who developed new-onset SFN after a documented COVID-19 illness. We collected demographics, symptoms, skin biopsy, iCPET testing, treatments, and clinical response to treatment or no intervention. Results: Sixteen patients were diagnosed with SFN on skin biopsy (median age 47, 75% female, 75% White). 92% of patients reported postexertional malaise characteristic of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and 7 patients underwent iCPET, which demonstrated neurovascular dysregulation and dysautonomia consistent with ME/CFS. Nine patients underwent treatment with IVIG, and 7 were not treated with IVIG. The IVIG group experienced significant clinical response in their neuropathic symptoms (9/9) compared with those who did not receive IVIG (3/7; p = 0.02). Discussion: Here, we present preliminary evidence that after COVID-19, SFN is responsive to treatment with IVIG and linked with neurovascular dysregulation and dysautonomia on iCPET. A larger clinical trial is indicated to further demonstrate the clinical utility of IVIG in treating postinfectious SFN. Classification of evidence: This study provides Class III evidence. It is a retrospective cohort study. 

Authors

Lindsay McAlpine, Adeel S Zubair, Phillip Joseph, Serena Spudich

Keywords

Humans; Female; Middle Aged; Male; Small Fiber Neuropathy; Case-Control Studies; Retrospective Studies; Fatigue Syndrome, Chronic; Post-Acute COVID-19 Syndrome; Immunoglobulins, Intravenous; COVID-19; Autonomic Nervous System Diseases