Neurological Complications during Treatment of Middle East Respiratory Syndrome

Kim, Jee-Eun; Heo, Jae-Hyeok; Kim, Hye-ok; Song, Sook-hee; Park, Sang-Soon; Park, Tai-Hwan; Ahn, Jin-Young; Kim, Min-Ky; Choi, Jae-Phil

A triple antiviral regimen was initiated on HD 1, with other treatments only including antiemetic, antitussive, and nonsteroidal anti-inflammatory drugs. Her clinical and radiological findings began to improve on HD 5, and oxygen therapy was stopped on HD 10. On the date of discharge (HD 10), she described a stinging pain in both hands and below the knees. She felt that her legs were weakened, and she had difficulty walking for 1 km independently. A neurological examination revealed symmetric proximal dominant lower leg weakness, with her proximal and distal muscles at MRC grades 4-and 4, respectively. She experienced normal sensations to pinprick, temperature, vibration, and proprioception. Her deep tendon reflexes were mildly diminished in both legs. Laboratory findings did not indicate the presence of any underlying autoimmune, infectious (except for a previous MERS infection), or nutritional diseases. Her creatine kinase level and the results of nerve conduction, electromyography, and evoked potential studies were normal. A CSF study was not performed. Her weakness began to improve 17 days after the original onset of the neurological symptoms, and had largely disappeared JCN after 53 days. However, tingling and pain in the four distal limbs continued until the last follow-up (approximately 7 months after symptom onset). This patient was presumed to have ICU-acquired weakness or GBS.