ABSTRACT
Case Diagnosis: A 72-year-old female who had COVID-19 in December 2020 who subsequently began to have signs and symptoms of ALS in January 2021. Case Description or Program Description: A 73-year-old female with untreated psoriatic arthritis, hypertension, hyperlipidemia, hypothyroidism, and recent COVID-19 infection (12/2020) was admitted on 7/28/2021 for rapidly declining functional status and multiple falls. Symptoms started as right hand weakness in January 2021 and subsequently she began to have recurrent falls resulting in multiple ED visits. On exam she had reduced facial temperature sensation, spastic quadriparesis (right> left), generalized hyperreflexia, positive Hoffman's and pectoralis reflexes bilaterally, upgoing toes bilaterally, and reduced hemisensory loss to temperature and vibration (right> left). CSF and EMG studies were consistent with ALS. Labs regarding autoimmune disease and genetic etiology were unremarkable. On the neurology unit, the patient was subsequently started on riluzole and weaned off Sinemet. PT and OT were involved. Initially, pre-gait attempts were limited by fatigue and all ADLs were maximum assist. Setting(s): Acute Inpatient Rehabilitation Unit Assessment/Results: During acute rehabilitation stay, patient progressed to minimum assist with ambulation using pneumatic support walker for 30ft. Additionally, patient progressed to modified independent with ADLs. However, patient remained moderate to maximum assist with both bed mobility and transfers. At day 17, patient was discharged home with appropriate DME, home therapies and aide, as well as 24/7 family support. Discussion (relevance): This is the first reported case, to our knowledge, of the onset of ALS promptly following COVID-19 infection. Conclusion(s): ALS may be considered on the differential diagnosis in patients with clinical signs and symptoms of functional decline and both upper and lower motor neuron deficits following COVID-19.