Exacerbation of syringomyelia/syringobulbia symptoms after COVID-19: Case report

In syringomyelia there is a known Substance P (SP) overexpression, predominantly in the external laminae of the dorsal horn. It has been hypothesized that several infections, particularly COVID-19, may increase the expression of the TRPV1 gene in lung, producing an increment of SP and IL-6, which would involve an alteration of the spinal trigeminal nuclei responsible for its secretion. The aim is to report the first case of exacerbation of syringomyelia/syringobulbia symptoms after a COVID-19 infection. A 42-year-old Hispanic female patient with history of syringomyelia/syringobulbia with Chiari malformation treated with decompressive surgery in 2019, presented to clinic in June 2020 complaining of close to 8 months of pain in the left upper limb, after suffering COVID-19 infection in August. One month later, the pain increased exacerbated by exertion, along with cold allodynia and tinnitus. Physical examination showed hypertension, anomic aphasia, cold allodynia with left hemitremor; dysesthesias, pain and weakness in left upper limb; lower limbs hyperreflexia; and bilateral Hoffman and Marinescu. Bloodwork showed elevated ESR and CRP. SARS-CoV-2 IgM and IgG were positive. MRI showed Chiari Malformation and syringomyelia/syringobulbia. The patient received COVID-19 treatment improving all features. Anecdotally when corticosteroids were weaned off pain returned; imposing a new corticosteroid regimen after which pain subsided returning to her daily living activities. This is the first case report of an exacerbation of syringomyelia/syringobulbia symptoms after COVID-19. We propose substance P as a key mediator for this kind of features.