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Brachial plexopathy as a complication of COVID-19
  1. Catherine Young Han1,
  2. Andrew M Tarr2,
  3. Alexandra N Gewirtz2,
  4. Ulrike W Kaunzner3,
  5. Paula Roy-Burman1,
  6. Todd S Cutler1 and
  7. Daniel JL MacGowan3
  1. 1Medicine, Weill Cornell Medical College, New York City, New York, USA
  2. 2Neurology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York City, New York, USA
  3. 3Neurology, Weill Cornell Medicine, New York City, New York, USA
  1. Correspondence to Catherine Young Han; cyh4001{at}med.cornell.edu

Abstract

COVID-19 affects a wide spectrum of organ systems. We report a 52-year-old man with hypertension and newly diagnosed diabetes mellitus who presented with hypoxic respiratory failure due to COVID-19 and developed severe brachial plexopathy. He was not treated with prone positioning respiratory therapy. Associated with the flaccid, painfully numb left upper extremity was a livedoid, purpuric rash on his left hand and forearm consistent with COVID-19-induced microangiopathy. Neuroimaging and electrophysiological data were consistent with near diffuse left brachial plexitis with selective sparing of axillary, suprascapular and pectoral fascicles. Given his microangiopathic rash, elevated D-dimers and paucifascicular plexopathy, we postulate a patchy microvascular thrombotic plexopathy. Providers should be aware of this significant and potentially under-recognised neurologic complication of COVID-19.

  • neurological injury
  • neuromuscular disease
  • pain (neurology)
  • peripheral nerve disease
  • infections

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Footnotes

  • Contributors CYH contributed to writing/manuscript preparation, writing the initial draft, making critical revisions and creating figures/tables. She aided with translation and patient communication. AMT contributed to writing/manuscript preparation, making critical revisions and creating figures/supplemental tables. He wrote portions of the paper including the summary. He was part of the neurology consult team that was involved in the patient’s care. ANG contributed to writing/manuscript preparation, making critical revisions and writing portions of the paper including the differential diagnoses. She was part of the neurology consult team that was involved in the patient’s care. UWK contributed to project conception, writing/manuscript preparation and critical revisions. She was part of the neurology consult team that was involved in the patient’s care. PRB contributed to writing/manuscript preparation, making critical revisions and finalising manuscript content. She contributed to direct patient care as the attending physician taking care of the patient. She also obtained final patient’s consent and patient’s quotations. DJLM contributed to analysis and interpretation of vital data as the consulting electromyographer and also made critical revisions of the manuscript. TC contributed to project conception, as project supervisor and as the attending physician taking care of the patient when the brachial plexopathy was initially investigated. He also made contributions to writing and critical revisions. All authors gave final approval of the case report before publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.