Objective: To present a case of a SARS-CoV-2 patient presenting with opsoclonus myoclonus syndrome who was successfully treated with IVIGs.

Background: The COVID-19 pandemic has caused high morbidity and mortality worldwide, often presenting with neurological manifestations of autoimmune origin. Opsoclonus myoclonus syndrome, a rare, autoimmune, idiopathic or paraneoplastic neurological disorder has so far not been described in SARS-CoV-2.

Method: Case report

Results: A 61-year-old African-American female with no neurological history, presenting with a one-week history of “generalized tremors,” changes in mental status, and sore throat was admitted for suspected COVID-19. During neurological evaluation, patient was found to be psychotic, disorientated, aggressive, with chaotic eye movements and extensive multifocal myoclonic jerks. Patient developed pulmonary distress requiring ventilation. Patient’s laboratory and radiological findings suggested acute COVID-19
which was later confirmed by antibody testing in spite of initially negative PCR tests. Extensive workup for autoimmune and paraneoplastic syndromes were negative.  Patient improved dramatically due to IVIG administration in the ICU, leading to early extubation. Patient made a functional recovery after two weeks of acute rehabilitation with normal physical and minimal cognitive complaints at six-month follow-up.

Conclusion: SARS-CoV-2 infection is multifaceted and may present as rare autoimmune neurological disorders such as opsoclonus myoclonus syndrome. We suggest both PCR and COVID-19 antibody testing routinely for patients presenting with suspected autoimmune or paraneoplastic movement disorders and suggest IVIGs as a possible treatment.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/sars-cov-2-encephalopathy-presenting-as-opsoclonus-myoclonus-syndrome-successfully-treated-with-iv-immunoglobulins/