Prolonged bilateral lower limb weakness: Is it due to COVID-19 or something else?

ABSTRACT

People who experience musculoskeletal symptoms during COVID-19 infection usually have long COVID-19. If a patient has symptoms after 30 days of COVID-19 infection, it is considered long COVID-19. Symptoms like pain, tenderness, and stiffness are common in the neck, back, and shoulders. Symptoms can be related to the body’s immune response to the virus. During complicated COVID-19 infection, patients may experience muscle weakness and decreased bone density, leading to osteoporosis attributed to prolonged bed rest and reduced physical activity.

Several disorders can cause bilateral lower limb weakness. Spinal disorders like cord com­pression caused by a tumor, herniated disc, infarction, cauda equina syndrome, and transverse myelitis can cause bilateral lower limb weakness. Inflammatory conditions like Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy (CIDP), inflammatory myopathy, and other conditions such as amyotrophic lateral sclerosis (ALS), multiple sclerosis, Parkinson’s disease, myasthenia gravis, or a pinched nerve can also cause bilateral lower limb weakness. In addition, potassium deficiency, tick paralysis, and leg weakness as a side effect of medication can present with bilateral lower limb weakness.

This case report presents a 59-year-old ambulatory patient with multiple underlying medical conditions who contracted COVID-19 and developed bilateral lower limb weakness, which did not improve even with vigorous physical therapy sessions, creating a challenge to find the underlying cause of weakness.

Keywords: COVID-19, lower limb weakness, musculoskeletal symptoms, creatine kinase, myalgia