Hereditary neuropathy and myasthenia under the 'mask' of post-COVID syndrome

Currently, more than 200 different symptoms and signs classified as "post-COVID syndrome" (PCS) have been described, including fatigue, shortness of breath, and muscle or joint pain. There are known cases of peripheral nervous system damage associated with COVID-19, such as Guillain–Barre syndrome, Parsonage–Turner syndrome, critical condition polyneuropathy, and others. The SARS-CoV-2 virus can damage not only the nervous system but also muscle tissue, as evidenced by reports of rhabdomyolysis and myositis in patients with COVID-19. Manifestations of peripheral nervous system and muscle pathology that arose during the acute phase of the disease may be observed for several months as part of PCS. However, if any symptoms persist for more than a year after COVID-19, alternative diagnostic options to PCS should be considered, since there is no information on the persistence of SARS-CoV-2 in the human body for more than 4 months or the chronic course of COVID-19. Various independent nosologies, including hereditary neuropathy and myasthenia, may be hidden under the 'mask' of the PCS diagnosis. COVID-19, as a severe acute infectious disease, may act as a trigger for the onset or progression of these diseases; coincidental comorbidity is also possible. A case report of patients with hereditary neuropathy and myasthenia, presenting under the “mask” of PCS, is presented. A thorough analysis of clinical, genealogical, and neurophysiological data, combined with the results of whole-genome sequencing, allowed for the diagnosis of distal hereditary motor neuropathy associated with a mutation in the GARS1 gene (7p14.3) (type V), with an autosomal domi- nant inheritance pattern (familial case), clinically manifesting as peripheral distal tetraparesis with mild gait impairment. Information collected in a timely manner in accordance with diagnostic criteria ensured successful surgical intervention for thymolipoma in patients with generalized myasthenia, seronegative, thymus-dependent, involving the oropharyngeal and axial muscles, without disruption of swallowing or breathing. Early detection of conditions masquerading as PCS allowed for adequate treatment, preventing progression and severe outcomes.

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