Atypical Onset of Tics and Obsessive-Compulsive Symptoms in FXTAS Following COVID-19: A Case Report

Individuals with premutation alleles of the FMR1 gene typically exhibit normal cognitive abilities in early and mid-life, unlike those with fragile X syndrome. However, as they age, approximately 40% of male and 16% of female carriers develop fragile X-associated tremor/ataxia syndrome (FXTAS). This neurodegenerative disorder is characterized by an intention tremor, cerebellar ataxia, and psychiatric disorders, such as anxiety, depressive, and neurocognitive disorders. While data on the impact of COVID-19 on FXTAS is still limited, examining this interaction is critical, given the widespread nature of the virus. In this case report, we describe a male premutation carrier with FXTAS who experienced an abrupt progression of motor and vocal tics along with obsessive-compulsive symptoms and cognitive decline following COVID-19 infection. This case suggests a potential link between the infection and the rapid onset of neuropsychiatric symptoms in a FXTAS patient, raising important questions regarding the involvement of immune responses in this interaction.