A case of probable tolosa-hunt syndrome co-occurred with covid-19 infection

ABSTRACT

Introduction: The novel coronavirus 2019 (COVID-19) pandemic started in Wuhan city, China in December 2019 and now the infection has a high prevalence worldwide and the pandemic is still ongoing. Symptomatic patients with COVID-19 typically complain of fever and respiratory, as well as gastrointestinal symptoms. It is known that human coronaviruses and particularly severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are neuroinvasive and neurotropic. There is growing evidence of various neurological complications and manifestations of COVID-19 infection. Neurological symptoms may range from mild, non-specific pre-sentations such as headache to severe complications both in the central or peripheral nervous system. Even rare neurological disorders can occur during or after this infection. Case presentation We report a case of a 65-year-old female with COVID-19 infection, who also developed left ophthalmoparesis with two cranial nerve palsies, which further was concluded to be a probable Tolosa-Hunt syndrome, an association not yet been described in the literature. The decision was made to treat with glucocorticosteroids, followed by dramatic relief of pain (which also speaks in favor of the diagnosis). Conclusion This report describes an interesting case of probable Tolosa-Hunt syndrome, a rare peripheral nervous system involvement syndrome, co-occurred with COVID-19 infection. Whether this was just a co-occurrence or the inflammation was triggered by a SARS-CoV-2 in-fection, is still a question to be discussed. The possible causal link between these two conditions may help to understand both conditions better.