The confocal microscopy of the cornea in post-COVID syndrome; the clinical observation

Abstract

One of the most important complications of the post-COVID-19 syndrome may be a small fiber neuropathy, which cannot be evaluated by a routine electroneuromyography. Confocal microscopy of the cornea (CCM) may be a promising method for early neuropathy verification. To study the possibility of the small fiber neuropathy evaluation using the CCM in a patient with the post-COVID-19 condition. The patient is a female of 61 years old, which suffered from a COVID-19 infection in October 2020. After a month, she noted the presence of myalgia and polyneuropathy. A year after the onset of the disease, in addition to myalgia, headaches, neuropathy pain, the patient also experienced bowel disorders and stomach aches, which cannot be explained with an alternative diagnosis. The patient underwent CCM to assess the structure of nerve fibers to prove the presence of the small fiber neuropathy as a complication of the COVID-19 infection. The presence of the small fiber neuropathy was evaluated in the patient as well as enlarged Langerhans cells in the cornea. Considering the pivotal role of these cells in the immunological processes, the "activated" dendritic cells in post-COVID-19 patients may serve as another evidence of the autoimmune nature of this complication and possibly, a method for the monitoring treatment effectiveness of this disease. In this clinical case of a 61-year-old patient with the post-COVID-19 syndrome, the possibility of application of the confocal microscopy of the cornea for the diagnosis of neuropathy of small fibers and monitoring of the patient›s condition is shown.