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. 2024 May;11(3):e200244.
doi: 10.1212/NXI.0000000000200244. Epub 2024 Apr 17.

Case-Control Study of Individuals With Small Fiber Neuropathy After COVID-19

Lindsay McAlpine  1 , Adeel S Zubair  1 , Phillip Joseph  1 , Serena Spudich  1
Affiliations

Case-Control Study of Individuals With Small Fiber Neuropathy After COVID-19

Lindsay McAlpine et al. Neurol Neuroimmunol Neuroinflamm. 2024 May.

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.

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Conflict of interest statement

The authors report no relevant disclosures. Go to Neurology.org/NN for full disclosures.

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