Post-infectious autoimmune disorder involving the CNS and PNS following SARS-CoV-2 infection – a clinical-morphological case report

Post-COVID can be associated with neurological symptoms such as neuropathy or fatigue. Histological analysis of affected nerves is rarely described and post mortem study of the brain and peripheral nerves are carried out only in few cases.In the case report, we describe the clinical and neuropathological findings of a 75-year-old female patient who presented with a motor and sensory axonal neuropathy after a SARS-CoV-2 infection seven weeks before and suddenly died. Laboratory testing of serum and CSF revealed no signs of systemic vasculitis or infectious diseases. A post mortem investigation was performed. Samples from the brain including the cranial nerves, peripheral nerves and skeletal muscles from different regions were analysed.The brain revealed lymphocytic cells predominantly in the basal ganglia and brain stem with involvement of the cranial nerves. Interestingly, a CNS involvement was not observed during lifetime. The sensory and motor peripheral nerves revealed a severe axonal neuritis. Skeletal muscle showed a neurogenic atrophy.This case report highlights that a post-infectious autoimmune disorder with CNS and PNS involvement should be considered in patients with post-COVID. The diagnosis of an ongoing inflammation may influence the treatment options.