key: cord-0762751-9ak33z7l
authors: Sanguinetti, Shayna Y.; Ramdhani, Ritesh A.
title: Opsoclonus-Myoclonus-Ataxia Syndrome Related to the Novel Coronavirus (COVID-19)
date: 2021-03-02
journal: J Neuroophthalmol
DOI: 10.1097/wno.0000000000001129
sha: 5403b4474a9c13b19e75c645b711e0ac3b6725a8
doc_id: 762751
cord_uid: 9ak33z7l

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any lesion or abnormality. A computed tomography (CT) of the chest, abdomen, and pelvis demonstrated bilateral ground glass opacities in his lungs-characteristic of COVID 19with no occult masses. A cerebrospinal fluid analysis was not conducted. He was afebrile and had mild dyspnea on exertion during his inpatient course but did not require supplemental oxygen. He was treated with 400 mg/kg/day intravenous immunoglobulin for 5 days and low-dose intravenous methylprednisolone 40 mg twice per day due to his diabetes. His clinical condition improved markedly over the course of the hospitalization, including disappearance of his opsoclonus and ocular flutter, reduction of his myoclonus, and improved gait.

This is the first described case of opsoclonus-myoclonus syndrome associated with COVID-19 infection. This novel coronavirus started to infect humans in Wuhan, China, in late 2019 and quickly spread throughout the world with the primary symptoms being dry cough, fever, and myalgias with more serious symptoms related to acute respiratory distress syndrome and sepsis. Neurological complications are estimated to be around 36% and include encephalopathy, seizure, stroke, myositis, and Guillain-Barré syndrome (2, 3) . The presence of SARS-CoV-2 polymerase chain reaction in the serum along with pulmonary findings on CT underscores the likelihood of a COVID-19 parainfectious etiology in this patient. Although the patient completed a course of hydroxychloroquine and azithromycin for his non-neurological symptoms, the possibility of either of the drugs inducing this neurological syndrome cannot be excluded. However, azithromycin has played a role in treating mycoplasma-induced OMAS (4), and there are no known reported cases of hydroxychloroquine-induced OMAS.

Although the pathophysiology of this syndrome remains unclear, it is postulated that opsoclonus and ocular flutter share a common pathway with impaired inhibition of saccadic burst neurons in the paramedian reticular formation and interstitial nucleus of Cajal (5) . Although a variety of infections such as HIV, West Nile virus, epstein barr virus, and enterovirus (1) have been associated with OMAS, there have been no known reports of COVID-19 or other coronavirus subtypes being triggers of it. The pathogenesis of parainfectious etiologies is believed to either be directly related to tissue invasion or the postinfectious immune response. Brain MRIs usually do not demonstrate an

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