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 46-year-old man with hypertension and a history of pulmonary tuberculosis was admitted due to infection with laboratory-confirmed MERS-CoV. He had previously experienced contact with patients with MERS in another hospital. At 4 days after this exposure, he developed a fever, coughing, chest discomfort, dyspnea, and stool loss. A chest radiograph displayed ground-glass opacities in his left lung. A triple antiviral regimen was initiated. No other drugs were administered that could cause peripheral neuropathy. Oxygen therapy was provided via a nasal prong and was increased to 5 L/min during admission. His pneumonia began to improve at 13 days after the onset of symptoms (HD 4), and the oxygen therapy was tapered off on HD 10. During this period he began to feel some tingling in the distal parts of his hands and feet. He denied experiencing any sensory symptoms prior to this admission. A neurological examination revealed normal mentation, cranial nerves, and muscle strength. He had bilateral decreases in pinprick and temperature sensations up to the knees and elbows. His reflexes were decreased at both knees but were normal in both upper extremities. His other neurological findings were unremarkable. The results of nerve conduction studies and quantitative sensory tests were normal. He was assumed to have infectious or toxic polyneuropathy, and his sensory symptoms gradually improved over 6 months.