Parsonage-turner syndrome associated with SARS-CoV2 (COVID-19) infection

Abstract

Parsonage-Turner Syndrome (PTS), also known as idiopathic brachial plexopathy or neuralgic amyotrophy, is an uncommon condition characterized by acute onset of shoulder pain, most commonly unilateral, which may progress to neurologic deficits such as weakness and paresthesias (Feinberg and Radecki, 2010 [1]). Although the etiology and pathophysiology of PTS remains unclear, the syndrome has been reported in the postoperative, postinfectious, and post-vaccination settings, with recent viral illness reported as the most common associated risk factor (Beghi et al., 1985 [2]). Various viral, bacterial, and fungal infections have been reported to precede PTS, however, currently there are no reported cases of PTS in the setting of recent infection with SARS-CoV2 (COVID-19). We present a case of a 17 year old female patient with no significant past medical or surgical history who presented with several weeks of severe joint pain in the setting of a recent viral illness (SARS-CoV2, COVID-19). MRI of the left shoulder showed uniform increased T2 signal of the supraspinatus, infraspinatus, teres minor, teres major, and trapezius muscles, consistent with PTS. Bone marrow biopsy results excluded malignancy and hypereosinophilic syndrome as other possible etiologies. Additional rheumatologic work-up was also negative, suggesting the etiology of PTS in this patient to be related to recent infection with SARS-CoV2 (COVID-19). Radiologists should be aware of this possible etiology of shoulder pain as the number of cases of SARS-CoV2 (COVID-19) continues to rise worldwide.

Keywords: Acute idiopathic brachial neuritis; Multisystem inflammatory syndrome in children (MIS-C); Neuralgic amyotrophy; Parsonage-turner syndrome; SARS-CoV2; Shoulder-girdle syndrome.

Fig. 1

Sagittal (A) and coronal (B, C) views of a fat-saturated T2-weighted sequence of the left shoulder demonstrates diffusely increased signal of the supraspinatus, infraspinatus, teres minor, teres major, and trapezius muscles.

Fig. 2

Sagittal (A) and coronal (B) views of a fat-saturated T1-weighted sequence of the left shoulder demonstrates no abnormal T1 signal, normal muscle volume, and lack of muscle atrophy or fatty infiltration.