Opsoclonus-Myoclonus-Ataxia syndrome (OMAS) associated with SARS-CoV-2 infection: Post-infectious neurological complication with benign prognosis

ABSTRACT

Objective: Etiology of Opsoclonus-Myoclonus Syndrome (OMAS) is multifactorial. This is a case of OMAS secondary to SARS-CoV-2 infection, and the clinical presentation suggests a postinfectious mechanism, possibly antibody-mediated. This case was seen on March 2020, at the beginning of this pandemic, and becomes a novel condition of the COVID-19 infection. Background: SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) is the cause of the COVID-19 pandemic. Reports from China have described ataxia and tremor as neurological symptoms of SARS-CoV-2 infection, but no OMAS. Opsoclonus is a rare phenomenon of combined multidirectional, involuntary, arrhythmic and chaotic saccadic oscillations, without an intersaccadic interval;myoclonus refers to brief, involuntary, irregular muscle contractions. Design/Methods: We describe a novel case of post-infectious OMAS with benign prognosis. Results: A 32 year-old man presented with cough, fever, weakness, and loss of appetite. He denied changes in smell or taste. His father had similar symptoms 5 days earlier, and both tested positive for SARS-CoV-2. He developed increasing fatigue and dyspnea, but denied wheezing or chest tightness. He had watery, non-bloody diarrhea throughout the febrile period, until his cough improved and he became afebrile 11 days after diagnosis. On day 12 he developed "tremors" and ataxia;the former confirmed as myoclonus on exam 2 days later. While hospitalized on days 17 to 20, evaluation revealed a chest X-ray consistent with viral pneumonia, and normal brain MRI. IgG antibodies were positive. Opsoclonus, myoclonus and ataxia (Videos 1 and 2) caused inability to ambulate without assistance. Initial treatment was effective and he was able to walk short distances without assistance. Telehealth follow-up on day 24 demonstrated substantial improvement of gait and balance (Video 3). No opsoclonus was observed, and he demonstrated only very mild ataxia and occasional myoclonus. Conclusions: This is a novel relation with SARS-CoV-2 infection, and needs to be included in the differential diagnosis .